腎細胞癌に対する根治的腎摘除術の治療成績 第1報: 腎癌取り扱い規約による進展度分類と予後

Abstract

根治的腎摘除術を施行した腎細胞癌症例106例を対象とした.原発腫瘍の進展度は, T1 2例, T2 58例, T3 42例, T4 4例で進展度別5年生存率は, T1 100%, T2 67.5%, T3 49.5%, T4 0%と原発腫瘍の進展度と予後はよい相関を示した.T1では静脈浸潤, リンパ節転移, 遠隔転移を認めず, T2では7%に静脈浸潤を, 14%に遠隔転移を認めたが, リンパ節転移を認めた症例はなかった.T3では38%に静脈浸潤を, 24%にリンパ節転移を, 38%に遠隔転移を認めた.T4では静脈浸潤, リンパ節転移, 遠隔転移を各々50%に認めた.根治的腎摘除術時に, 静脈浸潤, リンパ節転移, 遠隔転移を有した症例は, 各々22例, 12例下, 25例で, それらの症例の実測5年生存率は, 各々47%, 30%, 39%と, リンパ節転移, 遠隔転移, 静脈浸潤の順で予後不良因子と考えられた.遠隔転移を有した5例が, 根治的腎摘除術後3年以上生存し, 遠隔転移を有する症例にも積極的な腎摘除術が必要と考えられた

One hundred and six patients with renal cell carcinoma were treated with radical nephrectomy at our Department between 1970 to December, 1985. A retrospective analysis was performed with TNM staging system of The General Rule for Clinical and Pathological Studies on Renal Cell Carcinoma, which was established by the Japanese Urological Association in 1983. The 5-year survival rate according to pathological T-stage was 100% for 2 patients in pT1, 67.5% for 58 patients in pT2, 49.5% for 42 patients in pT3, 0% for 4 patients in pT4. Two patients in stage of pT1 had no venous involvement, lymph node metastasis, or distant metastasis. Twenty two patients had positive venous involvement (21%), 4 (7%) in stage of pT2, 16 (38%) in pT3, 2 (50%) in pT4. Twelve patients had positive lymph nodes (11%), 0 (0%) in stage of pT2, 10 (24%) in pT3, 2 (50%) in pT4. Twenty five patients, (24%) had distant metastasis at the time of nephrectomy, 8 (14%) in stage of pT2, 15 (38%) in pT3, 2 (50%) in pT4. The 5-year survival of 22 patients with venous involvement, 12 patients with lymph nodes metastasis, 25 patients with distant metastasis were 47%, 30%, 39% respectively. No significant difference of 5-year survival between 69% of 48 patients in T1 & 2VoNoMo (Robson-I) and 76% of 12 patients in T3VoNoMo (Robson-II) were considered to need the establishment of new classification for early stage of renal cell carcinoma. TNM staging system was thought to be better than Robson's Classification for analyzing the unique biological potential of renal cell carcinoma.