近年の腎盂,尿管癌臨床像の検討 ―単一施設の最近10年間99例の検討から―

Abstract

下大静脈に腫瘍血栓を合併した腎細胞癌14例を対象として, 血栓の進達度と手術の適応, 及び予後に関して検討した.腫瘍血栓の進達度は肝静脈下型10例, 肝静脈上型3例, 心内膜内型1例であった.手術施行はパフォーマンスステータスが0で, 原発巣, 転移巣が摘除可能と判断されたステージ3と4の9例であったが, これらは肝静脈下型6例, 肝静脈上型2例, 心内膜内型1例であった.手術時間は平均6時間53分, 平均出血量は2659mlで, 肝静脈上型の2例はいずれも平均より多かった.術後合併症は1例に狭心症発作を認めたが, 内服治療で管理できた.手術の9例の平均生存期間は53ヵ月で, 再発のない2例は8年後も生存している.非手術の5例の平均生存期間は7ヵ月であった

The aim of this study was to investigate recent characteristics and alterations of upper urinary tract cancer based on experience at a single institution over the past decade. Ninety-nine patients with renal pelvic and ureteral cancer resected at the Jikei University Hospital from January 1991 through December 2000 were retrospectively analyzed. Cancer-specific survival by pathologic stage, grade, and various clinical parameters were calculated by the Kaplan-Meier method. Prognostic factors for survival were examined with univariate and multivariate analysis. Cox regression analysis was used for multivariate analysis. Twenty-eight percent of cancers had been detected incidentally without having caused any symptoms. The overall 3-year and 5-year cancer-specific survival rates were 78% and 70%, respectively. The 5-year survival rate was 100% in patients with G1 cancer and 38% in those with G3 cancer. The 5-year survival rate was significantly higher in patients with cancers of lower grade (p = 0.0089), and was also higher in patients with cancers of stage pT1 or lower than in patients with cancers of stage pT2 and higher (p = 0.0038). The survival of patients with recurrence in the bladder was significantly longer than that of patients with recurrence in other organs. Multivariate analysis indicated that patient age and pT were the most important prognostic factors, followed by the presence of symptoms at diagnosis. The incidence of asymptomatic upper urinary tract cancer is increasing at institutions in Japan. We conclude that the cancer grade and stage still have classical predictive value, but that the presence of symptoms at the time of diagnosis is also an important prognostic factor.