腎孟尿管腫瘍の臨床的観察

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18年間に腎盂尿管腫瘍40例を経験した.病理組織学的には,移行上皮癌38例扁平上皮癌2例であったが,そのうち移行上皮癌のみにつき検討を加えた.1)発生頻度は3.2:1と男性に多く,60歳代,70歳代の順に多くみられた.2)低異型度,高異型度および低深達度,高深達度に分けると,異型度と深達度の間に従属関係がみられた.3) 5年生存率は全体で54.4%,部位別では腎盂54.4%,尿管48.4%であり,異型度別生存率には有意差はなかったが,低深達度と高深達度の間および脈管侵襲の有無では有意差がみられた.4)術後の膀胱内再発と異型度との関連性はみられなかったが,膀胱外再発は異型度が高いほど多い傾向がみられた.5)表在性腫瘍に対する術後膀胱内再発防止目的での各種抗癌剤の膀胱内注入や経口投与は,特にその効果を認めなかったDuring the 18 years from October, 1971 to September, 1989, 40 patients with renal pelvic and ureteral tumors were treated at our Department of Urology. Thirty were male and 10 female, and were between 44 and 83 years old with a mean age of 65.5 years. Histopathologically, there were 38 transitional cell carcinomas and 2 squamous cell carcinomas. There was a positive correlation between grade and stage of tumor. Among the patients with transitional cell carcinoma, the five-year survival rate was 54.4% for all the patients, 57.1% for patients with renal pelvic tumors and 48.4% for those with ureteral tumors respectively, as measured by the Kaplan-Meier's method. Stage and intravascular invasion of the tumor were the most influential factors for prognosis. There was no evidence in this series to show the usefulness of postoperative adjuvant chemotherapy, such as bladder instillation or peroral administration of various anti-tumor drugs, as a prophylactic use for recurrence of the bladder tumor in low stage cases.

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宮城徹三郎
石川県立中央病院

腎孟尿管腫瘍の臨床的観察

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