4回の外科的切除後に再発し, Medroxyprogesterone Acetateの投与で約2年間生存した再発性腎癌の1例

Abstract

62歳男。患者は無症候性肉眼的血尿を主訴とした。腹部エコーならびに腹部造影CT上より右腎に大きさ8cmの腫瘤が認められ, 右根治的腎摘術が施行された。病理所見では淡明細胞癌, G2>G1, pT1bN0M0の診断で, 術後は天然型Interferon-alpha(IFN-α)が10ヵ月投与された。しかし3年後, 腹部造影CTで左腎に腫瘤が確認され, 左腎部部分切除術が行われ, 術後は組換型IFN-α2bが1年間投与された。以後, 2年経過で胸部CT上で左S3b領域に腫瘤が認められ, 左肺上葉切除術が施行されたが, 9ヵ月後に左腎および副腎の再発を認めた。治療として左腎と副腎の部分切除術が行われたが, 3ヵ月後に再発し, リンパ節転移も認めた。IFN-α, MVP療法を施行したものの, 10ヵ月後にこれを中断, 20ヵ月生存し, 初診から9年後に患者は死亡となった。

A 62-year-old man visited our hospital complaining of asymptomatic gross hematuria. Right radical Computed tomography (CT) demonstrated an 8 cm mass in the right kidney. nephrectomy was done in March 1995, and the pathological examination revealed renal cell carcinoma (RCC), clear cell type, G2>G1. Interferon (IFN)-alpha was administered for 10 months. About 3 years later, in March 1998, CT showed 1 cm mass in the left kidney. Left partial nephrectomy was done and the pathological finding was RCC, G1. IFN-alpha2b was administered for a year. About 2 years later, CT showed 2.7 cm mass in the left lung. Left upper lobectomy was performed in August 2000, and it was a metastasis of RCC, G2. IFN-alpha and IFN-gamma were administered. Nine months later, in June 2001, the recurrence of the left kidney and the left adrenal gland was found and partial nephrectomy and adrenalectomy was performed. Pathological finding was RCC, G3. IFN-alpha and tegafur-uracil (UFT) were administered. Only 3 months later, recurrence of the left kidney and the left adrenal gland and the lymph node of renal hilus was found. We gave up for surgical resection and chemotherapy of MVP (Methotrexate, Vinblastine, Pepleomycin) was performed. Despite the therapy, disease progressed. 10 months after the last recurrence, in July 2002, patient became disoriented and hypercalcemia and the MVP therapy was stopped. After that, medroxyprogesterone acetate (MPA) and UFT were administered; the patient lived 20 months with relatively good performance status and died in February 2004. MPA might be considered as a drug for advanced renal cell carcinoma.