転移巣の手術を行った腎細胞癌症例の検討

Abstract

1)治癒的切除が施行された18例のうちM0群9例中3例, M1群9例中4例に癌なし生存がえられた. 2)非治癒的切除例では11例(M0群5例, M1群6例)中10例が原病死した. 3)予後, 生存率の改善には治癒的切除ができるかどうかが重要なポイントである.現況では, "癌なし"を目指し治癒的切除を試みることは有効な治療法と考えられた

The clinical experience with 29 renal cell carcinoma patients who underwent resection of their metastatic lesions was reviewed. Fourteen patients had no metastatic lesions when nephrectomy was performed initially (initial M0 group) and 15 patients already had detected metastases at diagnosis of their renal tumors (initial M1 group). The final point of follow-up was May 31, 1994. Eighteen patients (M0 9, M1 9) were curatively resected and 11 (M0 5, M1 6) underwent non-curative resection. In the curatively resected group, 7 patients (3 lung, 2 adrenal gland, 1 brain, 1 bone metastasis) were alive with no recurrence followed from 50 to 174 months. Eight died from tumor recurrences, 1 was alive with tumor recurrence and 2 died from other diseases. The 3-year and 5-year survival rates in the curatively resected group (16 patients, excluding 2 who died from other diseases) were 87.5% and 61.9%, respectively, according to the Kaplan-Meier method. On the other hand, the 3-year and 5-year survival rate in the non-curatively resected group were 36.4% and 27.3%, respectively. Between the curatively resected group and non-curatively resected group, a significant difference was shown concerning the survival rate (3 year: P = 0.0018, 5 year: P = 0.003, generalized Wilcoxon method). We concluded that curative resection was the most important prognostic factor in the treatment of metastatic lesions.