腎孟尿管腫瘍の臨床的観察

Abstract

1987年までの11年間に経験した腎盂尿管腫瘍60症例(男:47, 女:13, 平均年齢65歳)の臨床的検討を行った.1) Gradeとstageの間に高い相関をみた.2) Gradeおよびstageと転移の間に相関をみた.3)膀胱内再発を11例に認めた.4) Grade 1, grade 2およびgrade 3の5年生存は, それぞれ5/5例, 18/31例, 6/21例であり, grade 1とgrade 2, grade 1とgrade 3の5年生存率の間にそれぞれ有意差をみた.5) pT1以下, pT2, およびpT3の5年生存はそれぞれ18/20例, 2/10例, 8/20例(pT4は, 全例8ヵ月以内に死亡)であり, pT1以下とpT2, pT1以下とpT3の3年および5年生存率にそれぞれ有意差をみた.6) Category A, B間の5年生存率には有意差をみなかった.7)術後, 化学療法および放射線療法併用群の予後は良好であった.本検討より上部尿路上皮腫瘍のgradeおよびstageがその予後を左右するものと思われる

The 60 cases of primary renal pelvic and ureteral tumors treated at Mie University hospitals between January 1977 and December 1987 were reviewed and factors predicting the prognosis were investigated. The patients consisted of 47 men and 13 women (3.6: 1.0). Their ages ranged from 38 to 82 years with a mean of 65.2 years. According to Akaza's category classification of the ureteropelvic tumor, 42 cases were classified to category A, 15 cases category B and 1 case was classified to category C. Histologically, 59 transitional cell carcinomas and 1 squamous cell carcinoma were found. As to grading, 5 was G1, 31 G2, 21 G3 and 2 GX. As to staging, 20 were pT1, 10 pT2, 21 pT3, 3 pT4 and 6 pTX. Staging was correlated well with grading. Total nephroureterectomy with bladder cuff was performed on 39 patients and the other surgical treatments were done on 15 patients. Recurrence of the bladder tumor was found in 22.4%. The 5-year survival rate (Kaplan-Meier's method) was 47.8% for all of the patients. Among the patients with transitional cell carcinoma, the 5-year survival rate was 100% for G1, 57.6% for G2 and 28.6% for G3. As to staging the 5-year survival rate was 90.0% for below pT1, 20.0% for pT2 and 41.1% for pT3. The results from the present study suggest the prognosis is decided by grade and stage in pelvic and ureteral tumors, and it is wanted to develop a system of postoperative adjuvant therapy.