腎盂尿管腫瘍の臨床統計的検討

Abstract

1)1981～1991年までに腎盂尿管腫瘍86例を経験した。平均年齢は68.2歳で男に多く, 患側は左に多かった。2)主訴は無症候性の肉眼的血尿が最も多かったが, 膀胱腫瘍を含む他疾患精査中に発見されたものも12例あった。原発巣に対する手術は71例に対して施行され, うち51例に腎尿管全摘除術が行われた。3)組織学的には移行上皮癌がほとんどで, 全体にhigh grade, high stageであった。4)全症例での3年生存率は47.0%, 5年生存率は39.5%で, high grade, high stage症例, 尿管保存症例では予後不良であった。5)治療中およびその前後での膀胱腫瘍の合併が41.8%にみられた

We report 82 patients with renal pelvic and ureteral tumors admitted to Kyoto Prefectural University of Medicine, Kyoto Second Red Cross Hospital and Shakai-Hoken Kyoto Hospital between January, 1981 and December, 1991. Sixty two were males and 24 were females, and they were between 47 and 93 years old (average: 68.2 years). The tumor occurred on the right side in 34 patients, on the left side in 51 patients and on both sides in one patient. There were 43 renal pelvic tumors, 37 ureteral tumors and 6 renal pelvic with ureteral tumors. The most frequent symptom was macrohematuria, which was seen in 54 patients (62.8%). Urinary cytology was performed in 76 patients and a positive result was obtained in 44 patients (57.9%). We performed surgical treatment on 71 patients. The most frequently adopted method was total nephroureterectomy with partial cystectomy which was performed on 51 patients (71.8%). Of the 73 specimens diagnosed histopathologically, 71 specimens were transitional cell carcinoma (TCC), one was a squamous cell carcinoma (SCC) and one was a mixed type of TCC and adenocarcinoma. As to grading, 6 specimens were G1, 28 G2, 38 G3 and one GX. As to staging, 8 specimens were pTa, 17 pT1, 21 pT2, 18 pT3, 8 pT4 and one pTX. The overall survival rate (by Kaplan-Meier's method) at 3 and 5 years was 47.0% and 39.5%, respectively. The patients with high grade tumors and those who had ureter preservation, the survival rate was lower than in the other patients.