所属リンパ節転移を伴う腎細胞癌症例の検討

Abstract

1)1979～1993年迄の249例の腎細胞癌症例中, リンパ節郭清術又は生検術を188例に施行した.このうちの20例に組織学的なリンパ節転移を確認した. 2)大多数の症例では腎門部リンパ節に転移を認めた. 3)組織学的浸潤度・静脈浸潤の進んだ症例にリンパ節転移が多かったが, 原発巣の腫瘍最大径3cmの症例にもリンパ節転移を認めた. 4)治療としてのリンパ節郭清術の意義は, 現段階では遠隔転移のないpN1症例に限局された. 5)化学療法・免疫療法の有効である症例では, 転移巣の手術を含めた集学的な治療法の一環として, リンパ節郭清術の治療としての意義を認めた

A follow up study of 20 cases of renal cell carcinoma with regional lymph node metastasis at the department of urology in Niigata Cancer Center Hospital from 1979 to 1993 is presented. During this period, we treated 249 patients with renal cell carcinoma with or without lymph node metastasis. Lymph node metastasis could be estimated in 188 out of 249 patients. Histologically, lymph node metastasis was classified as pN1 in 8 cases, pN2 in 7 cases, and pN3 in 5 cases. The 3- and 5-year survival rates of 20 patients with lymph node metastasis were 45.0% and 16.4%, respectively. Nine of the 20 cases had no distant metastasis and 11 cases had distant metastasis. Three of the 9 patients with distant metastasis had no recurrence. Two of these 3 patients are still alive after 10 years and 3 years and 1 patient died because of acute heart failure. These 3 patients had pN1 metastasis smaller than 1 cm lymph node. Four of the 11 patients with distant metastasis had more than a two-year survival. However, 3 patients died due to renal cell carcinoma although primary and metastatic regions were resected and IFN with chemotherapy were given. Only one patient is still alive without recurrence after 3 years. This case detected as right renal cell carcinoma with pN2 metastasis and bilateral pulmonary metastasis was treated with radical nephrectomy with regional lymph node dissection and administered Methotrexate, VP16 and CisPlatinum chemotherapy and IFN.(ABSTRACT TRUNCATED AT 250 WORDS)