腎細胞癌偶然発見例に対する臨床的検討

Abstract

1985年1月～1992年12月までに, 三井記念病院泌尿器科において治療した偶然に発見された腎細胞癌(偶然発見癌)71例について臨床的検討を行った。偶然発見癌の頻度は増加しており, 過去3年間ではその割合は70%以上であった。偶然発見例のうち25例は健康診断にて46例は他の疾患の検査中に発見され, 47例は超音波検査にて24例はCTにて診断された。偶然発見例は症候癌に比べて有意に小さく, low grade, low stageであった。5年生存率は92.2%と予後良好であった

Between 1985 and 1992, 119 patients with renal cell carcinoma were treated at our hospital. Among these cases, 71 cases (59.7%) were incidentally detected in the absence of any suggestive clinical signs of a tumor, 41 cases (34.5%) presented urological or general signs suggestive of the tumor, and 7 cases (5.88%) were detected by metastatic lesions initially. We reviewed 71 cases of incidental carcinoma compared with 41 cases of symptomatic carcinoma. The ratio of incidental carcinoma has been increasing steadily for 8 years, and it was more than 70% of all cases in the last 3 years. The carcinoma was detected at routine health examinations in 25 cases, and during examination for unrelated diseases in 46 cases. Forty-seven cases (66.2%) were detected by ultrasonography, 24 cases (33.8%) by computerized tomography and none by intravenous pyelography. Tumor extension was within the renal capsule in 94.4% of the incidental carcinoma and the mean diameter was 4.39 cm, which was significantly smaller than that of symptomatic carcinoma (p < 0.0001). Peripheral tumors and clear cell subtype tumors were more frequently detected in incidental carcinoma (p < 0.0001 and p = 0.0018). Tumor stage and grade of tumor cell were significantly lower than symptomatic carcinoma (p < 0.0001). The five-year survival rate in incidental carcinoma was 98.5%. There was a significant difference in survival between the incidental and symptomatic carcinoma (p < 0.001).