進行腎細胞癌に対する腎摘除術の意義

Abstract

The value of nephrectomy for patients with advanced renal cell carcinoma is controversial. The negative opinion is that nephrectomy has not improved survival rates, and the affirmative one is that nephrectomy has been beneficial by relieving pain, fever or bleeding, and causing spontaneous regression of distant metastases. Therefore, we studied the clinical evaluation of surgical procedure for patients with advanced renal cell carcinoma. Of the 115 patients with renal cell carcinoma, who were admitted to our hospital during the past 24 years, 100 patients underwent surgery and 15 patients had inoperable cancer. The cancers of the 100 patients who underwent nephrectomy were graded from stages I to IV according to Robson's criteria. Thirty patients had stage I cancer, 25 patients had stage II cancer, 19 patients had stage III cancer and 26 patients had stage IV cancer. The results obtained were as follows. 1) The over-all observed survival rate of the 100 patients who had nephrectomy was 39.7% at 5 years and 33.7% at 10 years. On one hand, of 15 patients who did not undergo nephrectomy, 11 cases were dead within 1 year, 3 cases died between 1 and 3 years, and only one case lived for 5 years. 2) The observed survival rate of cases with stage I, II, III, IV cancer was 56.1, 53.0, 14.2 and 30.0%, respectively, at 5 years and 49.1, 37.5, 14.2 and 30.0%, respectively, at 10 years. The prognosis after nephrectomy for advanced renal cell carcinoma was better than was first expected, and the survival rate at 1 year was better than that of the inoperable patients. 3) Of the 26 patients with stage IV renal cell carcinoma, 2 lived for more than 10 years, and had spontaneous regression of bilateral pulmonary metastases. A 57-year-old Japanese male had had bilateral and multiple pulmonary metastases at nephrectomy, but these lesions disappeared 8 years after the operation. It is concluded that nephrectomy for advanced renal cell carcinoma is beneficial because there were more long-term survivals and spontaneous regression of distant metastases after nephrectomy.