原発性腎孟腫瘍の臨床的検討

Abstract

1)最近13年間に経験した16例の原発性腎盂腫瘍の平均年齢は63.9歳で, 男性は女性の4.3倍で, 患側に左右差は認められなかった.2)主訴は肉眼的血尿が13例ともっとも多く, ついで側腹部痛の2例であった.3) IVP所見としては, 陰影欠損が68.7%ともっとも多かった.ついで無造影腎が25%で, 造影群に比し予後不良であった.4)尿細胞診では, 自然尿では46.1%, RP時におけるカテーテル尿では50.0%の陽性率であった.5)手術法としては, 腎尿管摘出術兼膀胱部分切除術が9例ともっとも多く施行された.6)病理組織学的には全例が移行上皮癌で, stageとgradeがよく相関し, いずれも予後を決定する重要な因子であった.7)膀胱腫瘍併発の1例において術前と術後に1回ずつ経尿道膀胱腫瘍切除術を施行した.8)原発性腎盂腫瘍16例の1年生存率は86%, 3年生存率78%, 5年生存率68%であった.9) Low stage群とhigh stage群, low grade群とhigh grade群はp<0.05で生存率に有意差が認められた

Sixteen cases of primary renal pelvic tumor treated at our Department between July, 1971 and June, 1984, were reviewed. The sixth decade predominated over other age groups and occupied 47.3% of all cases (average: 63.9 years). The sex ratio was 4.3:1 with male patients predominating over female patients. The incidence of the affected side was equal; 8 cases in the right and 8 cases in the left renal pelvis. The most common initial symptom was macroscopic hematuria in 13 cases (81.2%), followed by flank pain in 2 cases (12.5%). The major findings in IVP were filling defect in 11 cases (68.7%) and non-visualizing kidney in 4 cases (25.0%). Positive urinary cytology was obtained in 6 cases (49.1%) by voided urine specimen and 4 cases (50.0%) by catheterized urine specimen. Histologically, all cases were transitional cell carcinoma; 11 of them were low stage and 5 were high stage at the initial diagnosis. Nine patients(56.1%) were treated by total nephroureterectomy associated with partial cystectomy. The over all survival rate at 1, 2, 3, 4 and 5 years was 86%, 78%, 78%, 68% and 68%, respectively, by the Kaplan-Meier method. The five year survival rate was 80% for the low stage group and 0% for the high stage group. (p less than 0.05, generalized Wilcoxon test). The five year survival rate was 83% for the low grade group and 40% for the high grade group. (p less than 0.05, Generalized Wilcoxon test) Among several factors, stage and grade of the tumor were the most influencing factors for prognosis.