腎細胞癌の静脈浸潤に関する臨床病理学的検討

Abstract

1)238例の腎細胞癌症例中, pV0:154例, pVla:41例, pVlb:23例, pV2:20例であった.pV2は右側が左側の4倍であった. 2)pV0とpVla症例の間には, 治療成績・原発巣の組織学的所見において, 有意の差を認めた. 3)pVlaとpVlbは, 生存率・原発巣の組織学的所見が, ほぼ同じ成績であった. 4)腫瘍血栓が高度に進行した症例でも, 遠隔転移がなければ, 良好な治療成績がえられた

To clarify the meaning of vein involvement, the clinical and pathological findings of the patients with renal cell carcinoma were examined. Out of 288 patients treated for renal cell carcinoma-from 1961 to 1993 at Niigata Cancer Center Hospital, 238 patients were examined for vein involvement. Tumor stages were evaluated according to the general rules for clinical and pathological studies on renal cell carcinoma (2nd edition). In 154 patients, the stage was pV0, in 41 pV1a, in 23 pV1b and in 20 pV2. The 5-year survival rate was 72.2% in pV0, 60.1% in pV1a, 51.9% in pV1b and 30.0% in pV2. Histological findings as grade, tumor size, regional lymph node metastasis and distant metastasis were proportional to vein involvement. The difference in the survival rate and histological findings of primary tumor between pV1a and pV1b group was small but the difference between pV0 and pV1a was significant. Therefore, the histological and clinical studies of the cases with pV1a must be done carefully. The 5-year survival rate of the patients with pV2 and without distant metastasis was 50.0%. However, the prognosis of the patients with pV2 and with distant metastasis was poor. Therefore aggressive treatment was not recommended for these patients.