腎孟尿管腫瘍における予後因子の検討

Abstract

腎盂尿管の上皮性腫瘍症例62例について生存に影響を及ぼす因子を検討した.1)生存曲線上, 年齢, 数, 多中心発生, 大きさ, 組織型, stage, 異型度, 発育様式, 浸潤増殖様式, リンパ管侵襲, 静脈侵襲の11因子が予後に関係していた.2)比例ハザードモデルによる単因子別での検討では, リンパ管侵襲, 発育様式, stage, 静脈侵襲, 年齢, 異型度, 多中心発生の7因子がこの順で有意に予後に関係していた.3)比例ハザードモデルによる多変量解析からは, リンパ管侵襲, 発育様式の2因子が予後因子として重要である

Sixty-two patients with epithelial tumors of the renal pelvis and the ureter were studied with respect to 16 clinicopathological factors and their relationship to the patients survival. The cumulative survival curves are depicted by the Kaplan-Meier method and the statistical difference in the survival rates were detected in 11 factors, age, tumor number, multicentricity, tumor size, histological tumor type, stage, grade, growth pattern, infiltration pattern, lymphatic invasion and venous invasion. Cox's proportional hazard model was applied to evaluate the contribution of these 11 factors to survival. With the univariate analysis, lymphatic invasion showed the greatest hazard ratio followed by growth pattern, stage, venous invasion, age, and grade in this order. Stepwise selection of these factors based on the relative magnitude of their contribution to the survival with Cox's proportional hazard model revealed the most important factor for survival as the lymphatic invasion (hazard ratio 5.29), followed by growth pattern (hazard ratio 2.89). In conclusion, patients with tumor lymphatic invasion and tumor of non-papillary growth pattern showed poor prognosis, and adjuvant chemotherapy should be performed on them to improve their survival.