下大静脈に腫瘍塞栓を伴う腎細胞癌の臨床的検討

Abstract

下大静脈腫瘍塞栓を有する腎細胞癌19例について臨床的検討を行った. 1)手術例は非手術例に比し, その予後がよい傾向にあり, 特に転移のない症例でその傾向が強かった. 2)組織学的にみると, clear cell subtype例は, granular cell subtype例より有意にその予後がよい傾向にあった. 3)下大静脈に腫瘍塞栓がある場合にも, 術前に詳細な画像診断を行い, 隣接臓器への浸潤の有無, 転移の有無, 転移の数, 腫瘍塞栓の位置等を考慮し, 症例を的確に選び, 積極的に手術療法を行うべきである

Nineteen patients with renal cell carcinoma with tumor extension into the inferior vena cava (IVC) were investigated between January, 1973 and March, 1994. The patients were between 50 and 78 years old with a mean of 65.9 years. The male to female ratio was 1.7 to 1. Thirteen tumors were on the right side and 6 on the left side. In 12 patients, both nephrectomy and removal of the tumor thrombus were performed. The survival rate in the operated group was 60% at 5 years. Histologically, 7 cases were diagnosed as clear cell subtype and 5 cases as granular cell subtype. From this study, an extended operative intervention such as radical nephrectomy combined with tumor thrombectomy of the IVC with or without cavectomy was suggested in the case of renal cell carcinoma without any other metastatic lesions and histopathologically of the clear cell subtype.