腎盂尿管腫瘍における術後再発様式に関する検討 : 腎盂腫瘍と尿管腫瘍の比較

Abstract

著者らは112症例を対象に腎盂腫瘍と尿管腫瘍における病期別のリンパ節転移の陽性率および術後再発様式を後方視的に検討した。その結果, 1)≦pT1の病期では腎盂腫瘍, 尿管腫瘍ともにリンパ節陽性例は認めなかった。だが, pT2/3では腎盂腫瘍29%, 尿管腫瘍23%に陽性例を認め, 両腫瘍において明らかな差異は認めなかった。2)術後遠隔転移の頻度は≦pT1, ≧pT2ともに尿管腫瘍で高かった。局所再発は腎盂腫瘍に頻度が高い傾向を認め, その理由の一つとしてリンパ節郭清範囲の不十分さの関与が示唆された。3)cN+腎盂腫瘍症例や≧pT2尿管腫瘍症例においては, 所属リンパ節よりさらに広範囲な郭清が局所再発予防に有用である可能性が示唆された。4)リンパ節郭清非施行群において術後局所再発, リンパ節再発を来たした症例はなく, ≦pT1症例でのリンパ節転移の頻度が極めて低かったことから, ≦pT1のような症例を適切に選択すれば, 必ずしも全例にリンパ節郭清をしなくても外科的治療の意義を損なわないと考えられた。

To determine treatment outcomes for renal pelvic and ureteral tumors, we retrospectively evaluated the correlations between stage, area oflymphadenectomy (LND) and the recurrence pattern. Of 162 patients treated surgically for a urothelial tumor of the upper urinary tract from 1990 to 2006, we reviewed 57 renal pelvic and 55 ureteral, diagnosed as having either renal pelvic or ureteral tumors. We defined local recurrence as metastasis to the retroperitoneum, pelvis, and abdominal lymph nodes. Of the 112 patients, LND was performed in 76. No patient with pTis/a/1 disease showed pN(+); however, in pT2 < or = disease, 39% of the renal pelvis and 23% of the ureter cases exhibited nodal involvement. During follow up, 35 patients had relapse; 25 distant metastasis, 5 local recurrence, and 5 synchronous recurrence at both sites. In pT2/3 disease, the frequency of distant metastasis of a ureteral tumor was significantly higher than that in renal pelvic cases (55% vs. 19%, P = 0.0237). Local recurrence was found in 7 renal pelvic and 3 ureteral cases. Although all of these patients had previously undergone LND, local recurrence adjacent to the dissected area was confirmed in 6 cases. In pT2 < or = disease, ureteral tumors showed more frequent occurrences of distant metastasis, whereas local relapses adjacent to the dissected nodal areas were more prominent in renal pelvic cases. When deciding a therapeutic strategy in renal pelvic cases, careful consideration about an adequate region for LND appears important.