腎盂尿管癌の臨床病理学的検討

Abstract

腎盂尿管癌62例について検討した. 1)膀胱癌併発率と種々の腫瘍因子との関連は, 明らかには認められなかったが, 腎盂・尿管の両方に腫瘍が見られたものでは他のものに比し併発率が高い傾向があった. 2)膀胱癌の併発と生命予後との関連も有意ではなかったが, 同時性にそれが見られたものでは予後不良の傾向にあった. 3)癌死の多くは遠隔転移に起因しており, 転移再発部位としてはリンパ節が最も多かった. 4)腫瘍部位(多発性)・異型度・深達度・浸潤増殖様式・静脈侵襲・リンパ管侵襲のいずれも有意な予後因子と考えられたが, 多変量解析では浸潤増殖様式と腫瘍部位の2因子のみが有意な変量として採用され, これらにつぐものはリンパ管侵襲であった

We investigated the clinicopathological features of 62 patients with transitional cell carcinoma of the renal pelvis and ureter. Four patients had been treated for bladder cancer. Among 58 patients without precedent bladder cancer, 6 had coexistent bladder cancer and bladder cancer subsequently developed in 13. The 5-year cause-specific survival rate was 33% in cases with coexistent bladder cancer, 75% in those with subsequent bladder cancer and 62% in patients without association of bladder cancer. Distant metastases were found in 23 of 62 (37%) cases, the most frequent site being lymph nodes. The site of the primary tumor (renal pelvis and/or ureter) and the pathological findings such as grade, stage, type of infiltration, venous and lymphatic invasion, were significantly correlated to cause-specific survival. Multivariate analysis showed the most influential factors to be the type of infiltration and the site of the primary tumor. Therefore, patients with INF beta or gamma tumors both in the renal pelvis and ureter had a poor prognosis. However, association of bladder cancer was not related to survival.