上部尿路に原発したと考えられる尿路上皮癌34例の経験

Abstract

1975年1月から10年間の上部尿路原発と思われる尿路上皮癌34例について検討した.1)腫瘍の発生部位は, 腎盂11例, 尿管21例, 腎盂尿管2例であり, 尿管腫瘍の4例は膀胱腫瘍を合併した.2)扁平上皮癌1例, 移行上皮癌33例であったが, 後者の1例では, gradeが不明であった.3)腎盂尿管全摘除術29例, 摘除術3例, 生検のみにとどめたもの2例であった.6例にはCAP療法を施行したが, 平均生存期間28. 3ヵ月, 最長生存期間は37ヵ月であり現在まで死亡例はない.4) Greade, stageのはっきりしているTCC 32例の実測生存率は, 3年および5年で65.5%と53.8%, 相対生存率は71.8%と63.5%であった.腎盂腫瘍と尿管腫瘍との間に, 予後の差はなかった.stage Aが良好な他は, B以上はごく不良であり, low grade, low stageのものも下部尿路における再発が多く, 厳重なfollowが必要と思われた

Thirty-four cases of tumor of the renal pelvis or ureter or both have been treated in our department during the past decade. The primary tumor was in the renal pelvis in 11 cases, in the ureter in 21 cases and in the ureter and renal pelvis in 2 cases, a co-existent tumor in the bladder was found in 4 cases. Seventeen patients had a tumor on the right side and 17 on the left side. The most frequent symptom was gross hematuria (70.6%) and flank pain was the presenting symptom in 7 cases (20.6%). On the intravenous pyelography, a filling defect in the renal pelvis or ureter (41.2%) and nonvisualization (53.0%) were frequent findings. Twenty-nine cases had undergone total nephroureterectomy with resection of a bladder cuff, 3 had simple nephrectomy and 2 had open biopsy alone. Postoperative radiation therapy was done in 1 case, chemotherapy in 10 cases, and 6 cases of them were treated by CAP therapy (cis-dichlorodiamine platinum, doxorubicin and cyclophosphamide). Actual and relative 5-year survival rates were 53.8% and 63.5%, and no significant difference was found in survival rate between the patients with renal pelvic tumors and those with ureteral tumors.