進行腎細胞癌の治療 : おもに転移巣に対する外科療法を中心に

Abstract

1964～1992年の間に治療した腎細胞癌患者279例中64例は遠隔転移があり, 55例は根治手術後の再発であった。14例で肺転移を切除したが, 片側転移例は両側転移例に比し生存が有意に良かった。18例で骨転移を切除したが, 予後は非常に不良で, グレード1の1例のみが3年以上生存した。又, 11例中9例でQOL (quality of life)が改善された。副腎転移単独は比較的予後が良かった。脳転移例は全例他の転移があるので, QOL改善の為に切除した。リンパ節転移は一般に予後不良であった。インターフェロンα-シメチジン併用療法施行転移癌25例中, 寛解を認めた9例は非寛解例に比し長く生存した

The prognosis of advanced renal cell carcinoma, especially with metastatic lesions was very poor. We described the outcome of surgical treatment of advanced renal cell carcinoma with metastasis. From 1964 to 1992, 279 cases of renal cancer were treated in the Department of Urology, the Center for Adult Diseases, Osaka. Sixty four cases were with distant metastasis (M1 case) and 55 cases were recurrent after radical nephrectomy (M0-M1 case). Among these 119 cases with distant metastasis, 50 cases were treated by surgical resection. Indication of surgical resection was first to obtain surgical complete regression (sCR), second to improve quality of life (QOL). Lung metastases from 14 patients (M1, 5 cases; M0-M1, 9 cases) were resected. The survival of patients with unilateral lung metastases was significantly better than that of patients with bilateral lung metastases. Bone metastases from 18 patients (7 cases to obtain sCR, 11 cases to improve QOL) were resected. The prognosis of patients with bone metastasis was very poor, and more than a 3-year survival was seen in only patients histopathologically with grade 1. QOL improvement was observed in 9 of 11 patients (82%). Solitary adrenal metastasis showed a relatively good prognosis. Surgical resection of brain metastasis was performed only to improve QOL, because all patients had other metastases. Lymph node metastasis showed in general poor prognosis. Six cases with tumor thrombus extending into inferior vena cava nephrectomized under extracorporeal circulation.(ABSTRACT TRUNCATED AT 250 WORDS)