腎盂腫瘍の臨床的観察

Abstract

平均年齢58.9歳の腎盂腫瘍男性18例, 女性4例で初発症状は血尿が72.7%, ついで側腹部痛であった.IVPでは陰影欠損と無機能腎を示した症例が同程度に認められた.尿細胞診の陽性率は65.7%であった.腫瘍組織はすべて移行上皮癌であり, 1例は腎結石を伴っていた.G1以下は無く, G2は5例, G3は13例で, stage Oは1例, A 4例, B 5例, C 6例, D 2例で両者間に相関性を認め予後に影響する因子として重要であった.術後の尿路上皮性腫瘍の発生は, 対側腎盂に1例, 膀胱に8例認められた.膀胱腫瘍の大半は術後2年以内に発生した.5年実測生存率は58.2%であった.腎尿管全摘除術を施行したものは18例であった.術後放射線療法施行したもの5例, 化学療法4例, 両者併用は1例であった.現在のところ術後補助療法として有効なものはなかった

A retrospective study was conducted on 22 patients with renal pelvic tumor treated at our University Hospital between 1970 and 1984. The patients included 18 males and 4 females, from 31 to 81 years of age. The left kidney was involved in 14 cases, and the right in 8. More than 60% of them also presented gross hematuria. IVP abnormalities included filling defects in 9 cases and non-visualizing kidney in 8 cases. Pretreatment urinary cytology was positive in 65.7%. Radical nephroureterectomy was performed in 18 cases, followed by adjuvant therapy in 10 cases; radiation in 5 cases, chemotherapy in 4 cases, and radiation/chemotherapy in one case. Histology revealed transitional cell carcinoma in all cases. On diagnosis, simultaneous urothelial tumors were identified in one case in the ureter and the bladder, and in one case in the bladder. Tumor development after surgery was observed in 9 cases, 8 in the bladder and one in the ipsilateral renal pelvis. The 5-year actual survival rate was 58.2% over all: that of the low-grade group was 100%; that of the high-grade group, 45.1%; that of the low-stage group, 100%; that of the high-stage group, 19%. In conclusion, the prognosis in our series was significantly influenced by the stage and grade of the tumor.