腎細胞癌における早期癌の検討 : 腫瘍最大径からみた治療成績に基づいて

Abstract

当病院で経験した腫瘍最大径が測定可能であった250例の腎細胞癌症例を対象として, 腫瘍最大径別にその治療成績を検討した結果, 腫瘍最大径が3cm以下で, 遠隔転移やリンパ節転移を認めない症例を早期腎細胞癌と定義できる

In this study we tried to define the term "early renal cell carcinoma" from the study of pathological and clinical findings of renal cell carcinoma according to tumor size. During the 33 years from 1961 to 1993, 288 patients with renal cell carcinoma were treated in Niigata Cancer Center Hospital. In 250 of the 288 cases, tumor size was measurable. The average tumor size was 6.9 +/- 3.4 cm (from 1.5 cm to 17 cm). First we divided renal cell carcinoma into four group according to tumor size; under 2.5 cm (n = 32), 2.5-5 cm (n = 67), 5-10 cm (n = 108) and over 10 cm (n = 43). The 5-year survival rate was 89.2, 71.4, 54.3 and 33.2% respectively. The survival rate for tumors under 5 cm in size was significantly higher than that for tumors over 5 cm in size (p < 0.01). Then the tumors under 5 cm were analyzed for every centimeter in tumor size. The survival rate was 89.9% for tumors under 2 cm (n = 22), 94.1% for 2-3 cm (n = 18), 85.2% for 3-4 cm (n = 25) and 61.8% for 4-5 cm (n = 32). None of the patients with tumors under 3 cm died of renal cell carcinoma. One patient with distant metastasis and another patient with regional lymph node metastasis were found among the patients with tumors under 3 cm in size but these two patients are now free from the disease. Recurrence was not found in the patients with tumors under 3 cm in size. There was little vein involvement in the cases under 3 cm (2/37). From these findings, we define the early renal cell carcinoma as the cases in which the tumor is under 3 cm in size and without distant or lymph node metastasis.