最近の腎細胞癌症例の臨床的特徴に関する検討(1979年以前と1980年から1984年までの症例比較)

Abstract

1957年1月より1979年12月末までの23年間に治療した169症例(前期症例)と1980年1月より1984年12月までの5年間に治療した165症例(後期症例)を比較した.診断時年齢では前期(平均56歳)が後期(61歳)より有意に若年であった.診断時徴候については, 尿路症状は前期に多く, 逆に尿路外症状や, 偶然発見例は後期症例に有意に多かった.術式については, 後期では腹膜外式が少なくなり逆に経腹式または経胸膜式到達法が増加した.原発巣に対する放射線照射は後期では認められなくなった.化学療法は, 前期ではFMC療法, MACV療法が多く施行され, 逆に後期ではFAV療法やIFNを中心にしたBRM療法が多く行われた.Stage分布では, 前期症例にstage 2が多く, 逆に後期にStage 4が多かった.生存率(5, 10年)については前期と後期で差異はみられなかった.しかしlow stage (stage 1, 2)症例の生存率が最近, 改善されつつある傾向が認められた

Patients with renal cell carcinoma treated at Jikei University and affiliated institutions were studied with regard to temporal differences. Our study population was divided into two groups: an earlier group comprising 169 patients treated between January 1957 and December 1979, and a later group comprising 165 cases treated between January 1980 and December 1984. The mean age in the earlier group was 56.2 years, while that in the later group was 60.4 years. Therefore, the patients in the earlier group were generally younger than those in the later group. Patients in the earlier group were more likely to present with urinary symptoms at the time of diagnosis. On the other hand, patients in the later group were more likely to present with extra-urinary symptoms or to be asymptomatic. The time period between the onset of symptoms and initial consultation with physician was longer (within one month) in the earlier group. Most patients in the later group underwent nephrectomy using the transperitoneal or thoracoabdominal approach. Few patients in the later group were treated with radiotherapy. As adjuvant chemotherapy, MFC (MMC, 5-FU and Ara-C) or MACV (methotrexate, actinomycin D, cyclophosphamide and vincristine) regimen were most commonly employed in the earlier group. FAV (5-FU, adriamycin and vinblastine) regimen or interferon therapy which was classified as biological response modifiers (BRM) were more commonly employed in the later group. More cases were diagnosed as stage II in the earlier group, and more cases were diagnosed as stage IV in the later group. No significant differences were observed between the earlier and later groups, with regard to 5- and 10-year survival rates.(ABSTRACT TRUNCATED AT 250 WORDS)