腎盂・尿管腫瘍の臨床的観察

Abstract

1975年1月から1985年12月までの11年間に当施設および関連病院で経験した37例の腎盂尿管腫瘍に検討を加え, 同期間に経験した膀胱腫瘍241例とも比較検討した.対象の平均年齢は65.2歳, 男性26例女性11例, 腎盂腫瘍15例, 原発性尿管腫瘍19例, 腎盂尿管重複腫瘍3例であった.主訴は肉眼的血尿が89%と最も多く, 症状発現から初診までの期間は1ヵ月以上3ヵ月未満が35%と最も多かった.尿細胞診の陽性率は69%で, 高gradeの例に陽性率も高かった.35例に手術を行い, うち22例は腎尿管全摘除術であり, 35例の5年生存率は68.0%で膀胱腫瘍のうち膀胱全摘除術を施行した34例の5年生存率76.5%と比べやや不良であった.High gradeあるいはhigh stageの症例は予後不良の傾向があったが, high gradeでもlow stageのものは予後良好であった.化学療法施行群と非施行群の間に有意差は認められなかった

Thirty-seven cases of renal pelvic and ureteral tumors treated at our hospitals between January, 1975 and December, 1985 were reviewed. There were 15 renal pelvic tumors, 19 primary ureteral tumors and 3 ureteropelvic tumors. There were 26 males and 11 females and their average age was 62.5 years old ranging from 37 to 82. The most frequent chief complaint was macroscopic hematuria, which was seen in 89% of the patients (33/37). It was 35% of the patients (13/37) who visited our hospitals more than one month but less than three months after the appearance of symptoms. The positive rate of urine cytology was 69%. Total nephroureterectomy was performed on 22 patients and the other surgical treatments were done on 13 patients. Histological examination revealed transitional cell carcinoma in all cases. The overall actual postoperative survival rate at 1, 3 and 5 years was 83.9%, 68.0% and 68.0%, respectively, as measured by the Kaplan-Meier's method. None of the patients who survived more than 3 years after surgery died. The actual 3 and 5 year survival rates in cases of ureteropelvic tumors were slightly lower than those in the case of bladder tumors. There was no evidence in this series to show the usefulness of postoperative adjuvant chemotherapy.