偶然発見された腎細胞癌の臨床的検討

Abstract

1974年1月より1990年12月までの間に, 大阪労災病院泌尿器科において治療した偶然発見腎癌32例について検討した.1)男性25例, 女性7例で男女比は3.6:1であり, 年齢は39歳から84歳, 平均61歳であった.2)患側は右14例, 左17例, 両側同時期1例で左右差は認めなかった.3)年次別発生頻度では, 1987年以降年々腎癌症例数が増加してきておりそのうち偶発癌の占める割合も増加傾向にあった.4)初診時の主訴は, 人間ドックなどの健康診断で発見されたものが7例, 21.9%と最も多く, 初診時受診料では内科が19例, 59.4%と最も多かった.5)発見の契機となった検査法は90%近くが腹部超音波検査かCTスキャンであった.6)腫瘍径の大きさでは5 cm以下のものが19例, 59.4%と臨床癌群, 潜在癌群に比し有意に多く, pT分類ではpT2が多かった.7) 5年生存率は52.2%であり潜在癌群(28.9%)との間に有意差を認めたが, 臨床癌群(55.1%)との間には統計学的有意差は認められなかった

Of 93 patients with renal cell carcinoma treated at our hospital between January 1974 and December 1990, thirty-two cases with incidentally detected cancer were evaluated clinically and pathologically. The average age of the patients was 61 years old ranging from 39 to 84 years. There were 25 men and 7 women with a sex ratio of 3.6:1. Fourteen tumors had developed in the right kidney and 17 in the left kidney. One patient had bilateral tumors synchronously and was treated by radical nephrectomy with contralateral enucleation of the tumor. The proportion of incidental renal carcinoma has been increasing steadily; 87.5% of the cases was found by either abdominal ultrasonography or CT scan. Nineteen patients (59.4%) had a tumor smaller than 5 cm in diameter. There were 29 cases with G1 or G2 renal cancer and twenty with pT2. The five-year survival rate in the incidental cases was 52.2% with significantly better survival than in cases when metastasis was initially suspected, but there was no significant difference in survival between the incidentally found cases and the cases of symptomatic renal cancer.