最近25年間に経験した腎盂腫瘍

Abstract

The 55 cases of transitional cell carcinoma of the renal pelvis seen at Kyoto University Hospital between 1955 and 1979 were reviewed and factors predicting the prognosis were investigated. Patients ranged in age from 37 to 86 years, with a mean of 64.2. There were 42 men and 13 women, or a ratio of 3.2: 1.0. Thirty-three tumors were found on the left side, 22 on the right side. According to the modified Batata's stage classification of the ureteral tumor, 7 cases were classified stage A, II cases stage B, 21 cases stage C and 16 cases stage D. 1. Over-all relative survival rate at 1 year, 2 year, 3 year, 5 year, 10 year were 90.9%, 79.5%, 65.1 %, 54.5%, 52.1 %, 44.7%, respectively. 2. Survival was more dependent on the stage than the grade of the tumor. There was no difference between stage A and B in the estimated survival rate for a 1O-year follow-up. Five and 10 year survival rates were 71.4% and 71.4% in the stage A, 76.7% and 57.5% in the stage B, respectively. Although a 2-year survival rate of stage C was superior to the overall survival rate, patients with stages C and D had an ominous prognosis beyond a 3-year follow-up. Five and 10 year survival rates were 31.9% and 19.7% in the stage C, 15.3% and 15.3% in the stage D, respectively. 3. There was a strong correlation between IVP findings and tumor stage. The prognosis of patients presenting with a non-visualizing IVP is poor generally beyond a 2-year follow-up. Preoperative values of erythrocyte sedimentation rate were dependent on the stage of the tumor and especially, more than 50 mm of erythrocyte sedimentation rate (I hour) indicates a poor prognosis. 4. Ipsilateral ureteral tumors were noticed simultaneously in 14 patients (25.5%) who had high grade and high stage tumors. Postoperatively, bladder tumors occurred in 17 patients (30.9%). Most of tumors were found within 2 years following the operation. In general, 3-, 4- and 5-year survival rates were lower in patients with associated uroepithelial malignancies, however, this reflected a poor prognosis of patients with simultaneous ureteral tumors. The occurrence of bladder tumors, per se, did not affect the overall outcome. 5. A comparison of the prognosis between two series of different operative modalities was made. One series comprising 30 patients was operated with nephrectomy with extirpation of varying length of the ureter. The other series comprising 25 patients had surgery of total nephroureterectomy with cuff. The survival rate beyond a 2-year follow-up was higher in the latter than in the former. Recurrence of the bladder tumor was found in 37% in the former and 24% in the latter but those figures were not significant statistically. In conclusion, the following clinical features indicate a poor prognostic outcome of this tumor. i) Over 64-year-old of the patient’s age at the initial presentation. ii) Non-visualized kidney on IVP. iii) More than 50 mm of 1 hour value of erythrocyte sedimentation rate. iv) Operative modality of nephrectomy with incomplete resection of the ureter. v) Pathologically high stage of the extirpated pelvic tumor. vi) Simultaneous association of the ureteral tumors.