腎細胞癌におけるリンパ球浸潤を含む病理組織像と予後に関する検討

Abstract

根治的腎摘除術を施行し, 病理組織学的に腎細胞癌と診断した50例を対象として, リンパ球浸潤を含む病理組織像と予後に関する検討を行った. 1)腎細胞癌の予後規定因子として腫瘍径, 発育様式, 腎周囲脂肪織浸潤, リンパ節転移及び遠隔転移, 静脈浸潤, 異型度が考えられた. 2)腫瘍内及び周囲のリンパ球浸潤について検討すると明らかに浸潤がみられる症例は, 浸潤がみられない症例に比べ予後が良好な傾向を認めた.腫瘍内及び周囲のリンパ球浸潤は, 良好な予後因子となる可能性が示唆された. 3)原発腫瘍に比べ静脈浸潤は28例中3例, 転移巣は9例中6例で異型度の悪化が認められたが, 予後との関係は明らかではなかった

We compared the prognosis with the histopathological findings including intravenous invasion and lymphocytic infiltration inside or adjacent to the primary tumor in 50 renal cell carcinoma patients who underwent radical nephrectomy. We compared the primary tumor to intravenous invasion or metastases in histopathological findings. One-, three- and five-year survival rates for all patients were 91.7, 71.5 and 60.7%, respectively. Significant prognostic factors were tumor size, growth pattern, invasion of fat tissue into peripheral kidneys lymph nodes, distant metastases, intravenous invasion and tumor grade, especially lymph nodes and distant metastases (P < 0.001). Degree of lymphocytic infiltration inside or adjacent to primary tumor was divided into three groups. Five-year survival rates were 86.2% of the patients (n = 15) with apparent lymphocytic infiltration and 48.8% of the patients (n = 18) had few infiltrated lymphocytes. The patients with apparent lymphocytic infiltration showed a trend of better prognosis compared to the patients with few infiltrated lymphocytes (P < 0.1). Tumor grade was higher in 3 of the 28 patients with intravenous invasion and 6 of the 9 patients with distant metastases than in those with primary tumors. However, there was no significant correlation between prognosis and malignant potential of intravenous invasion or distant metastases.