腎細胞癌の臨床的研究

抄録

Eighty-one patients with renal cell carcinoma encountered in 22 years from 1953 to 1974 were clinically observed.
1) Encounter rates with such patients were 0.16% of outpatients and 1.2% of inpatients.
2) The right and left kidneys were affected with equal frequency. Male patients were more commonly affected, the ratio being 3.8 to 1.
The average age of patients was 56.7 years old.
3) As the initial symptoms, gross hematuria was most frequent (40 cases, 51.2%), followed by nonurologic symptoms (22 cases, 28.2%). This figure (28.2%) seemed to be unexpectedly high. It turned out that the symptoms in 6 cases of the 22 cases had been caused by metastasis.
4) As the classic triad, gross hematuria was most frequent (52 cases, 66.7%), followed by renal mass (38 cases, 48.7%) and flank pain (25 cases, 32.1%). In this connection, 13 cases (16.7%) had none of triad, while only 6 cases (7.7%) had complete classic triad.
5) Nonurologic symptoms were recognized in 53 cases (67.9%). In details, pyrexia (29 cases, 37.2%), generalized fatigue (20 cases, 25.6%), loss of weight (17 cases, 21.8%), anorexia (9 cases, 11.5%), gastorointestinal symptoms, varicocele and symptoms caused by metastasis were observed.
6) The results of hematologic and blood chemical examinations were as follows. Accelerated erythrocyte sedimentation rate was found in 48 cases (61.5%). Anemia was recognized in 14 cases (17.9%), polycythemia being observed in only 1 case (1.3%). Hypercalcemia was found in 8 cases (11.9%) and alkaline phosphatase at a high level was seen in 13 cases (20%). The serum protein fraction was characterized by the increases in α₂-globulin and γ-globulin. In the subfraction, on the other hand, remarkable increase in haptoglobin was recognized.
7) As diagnostic techniques, pyelography, nephrotomography, renoscintigraphy and renal angiography were most contributory, and RI-angiography was used for 13 cases and proved to be useful.
8) As the therapeutic method, nephrectomy was performed for 68 cases (84%), radiation therapy for 56 cases (72%), chemotherapy for 57 cases (73%).
9) In 10 cases metastasis was found when the renal cell carcinoma was discovered, while in 24 cases metastasis occurred after operation. As to the location and number of metastasis in a total of 34 cases, the lung was most frequent (24 cases, 70.6%), followed by bones, lymph nodes, liver and kidney.
10) The 5-year survival rate of 81 cases observed in the present study was 46.7%, and the rate of 68 cases whose kidneys had been excised was 53.6%. The most important factors of the prognosis were the stage of tumor and renal vein invasion. Patients with elevated erythrocyte sedimentation rate, anemia or dysproteinemia had also distinctly unfavorable prognosis.