腎腫瘍の臨床的検討

Abstract

1970年～1980年までの過去11年間に経験した腎腫瘍71例につき検討した.発生頻度は外来患者総数の0.22%, 入院患者総数の1.72%であった.全症例のうち腎腺癌が41例(57.7%), 腎盂移行上皮癌が23例(32.4%), 左右差は無く, 男性にやゝ多く, 平均年齢55.9歳であった.臨床症状としては肉眼的血尿が73.2%, 腎部腫瘤45.1%, 発熱36.6%で, 腎腫瘍の古典的三大症状は2例に認めたのみであり, 大部分が初発より1年以内に来院していた.転移は42.2%に認め, 肺転移が23.1%に見られた.診断には1VP, 血管造影法が有用で, 腎盂悪性腫瘍ではこれらの他尿細胞診が有用であった.予後判定には検査成績のうち, 血清蛋白分画, 血沈値が役立った.手術療法では根治的腎摘出術が83.0%に, 腎尿管全摘除術が88.5%にそれぞれ行なわれていた.5年生存率は腎腺癌で42.7%, 腎盂悪性腫瘍で53.0%, 共に放射線療法の併用の予後が最も良かった

Seventy one patients with renal tumors treated at our clinic during the 11 years from 1970 to 1980 were clinically examined. The results are summarized as follows. The frequency of patients with renal tumors was 0.22% of the outpatients and 1.72% of the inpatients. Of the 71 renal tumors, 41 were renal adenocarcinoma, and 26 were renal pelvic tumors of which 23 were transitional cell tumors, 2 were squamous cell tumors, and 1 was adenocarcinoma. The other tumors were 1 adenoma, 1 hemangioma, 1 hematoma, and 1 foreign body granuloma. The right and left kidneys were affected at equal frequencies. Male patients were more commonly affected, the sex ratio being 39 to 32. The youngest case was a 29-year-old female, and the eldest was a 84-year-old male. As the initial symptoms and chief complaints, gross hematuria was most frequent (52 cases, 73.2%), followed abdominal tumor mass (32 cases, 45.1%), and fever (26 cases, 36.6%). Only 2 cases showed the classic triad, while 1 case had none of them. The period between onset of symptoms and admission, was within 1 year for all patients except for 2 cases. Metastasis was found in 52 cases. The lung was the most frequent site of metastasis (12 cases, 23.1%), followed by lymphnodes, bones, and liver. The clinical examinations performed and diagnostic techniques used were, renal function (BUN, Serum Cr), Hb, WBC, liver function (T. Bil, GOT, GPT), serum protein fraction, serum LDH, serum Ca, ESR, tumor marker (AFP, CEA), urine cytological examination, blood pressure, IVP (or RP), angiography. As the therapeutic method, nephrectomy was performed in 25 cases (35.2%), combined nephrectomy and irradiation therapy in 12 cases (16.9%), combined nephrectomy and chemotherapy in 11 cases (15.5%), combined nephrectomy and other therapy in 15 cases (21.1%), and conservative therapy in 8 cases (11.3%). For the entire traced series of renal tumors, the 1-, 3-and 5-year survival rates were 72.3, 49.8, and 49.8% respectively. For renal parenchymal tumors (renal adenocarcinoma), the 1-, 3-and 5-year survival rates were 77.8, 53.0, and 53.0%. The most important factor of prognosis was the stage of tumor. Patients with elevated erythrocyte sedimentation rate, and dysproteinemia also had distinctly unfavorable prognosis. In this study of therapy, the highest survival rate was seen for the patients treated by combined nephrectomy and irradiation therapy of both renal parenchymal and pelvic tumors.