腎癌の手術における同側副腎摘除の意義  [in Japanese] THE SIGNIFICANCE OF IPSILATERAL ADRENALECTOMY AT SURGERY FOR RENAL CELL CARCINOMA  [in Japanese]

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Author(s)

    • 駒井 好信 KOMAI Yoshinobu
    • (財)癌研究会有明病院泌尿器科 Department of Urology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research
    • 藤井 靖久 FUJII Yasuhisa
    • (財)癌研究会有明病院泌尿器科 Department of Urology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research
    • 須山 太助 SUYAMA Taisuke
    • (財)癌研究会有明病院泌尿器科 Department of Urology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research
    • 大久保 雄平 OKUBO Yuhei
    • (財)癌研究会有明病院泌尿器科 Department of Urology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research
    • 山本 真也 YAMAMOTO Shinya
    • (財)癌研究会有明病院泌尿器科 Department of Urology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research
    • 米瀬 淳二 YONESE Junji
    • (財)癌研究会有明病院泌尿器科 Department of Urology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research
    • 福井 巌 FUKUI Iwao
    • (財)癌研究会有明病院泌尿器科 Department of Urology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research

Abstract

(目的) 腎癌における同側副腎または浸潤(IADI)の頻度を示し,腎摘除における同側副腎摘除の意義について検討した.<br> (対象と方法) 1981年から2007年までに病理学的に腎癌と診断された588例のうち,評価可能な426例を対象とした.腎癌に対する手術施行時に同側副腎を摘除した193例(AD群)と温存した233例(AS群)とを比較検討した.<br> (結果) AD群のうち5例(2.6%)に(IADI)を認め,全例においてT4またはM1を呈していた.原発巣と副腎病変の連続性から,5例のうち3例が直接浸潤,2例が転移と考えられた.IADI陽性例では全例で術後腎癌の進行がみられ,4例は癌死した.インターフェロン療法が奏効した1例のみ肺転移ありで31カ月生存している.対象のうち8例(1.8%)で術前CTにより同側副腎の異常が指摘され,そのうち4例でIADIを認めた.IADI陽性の5例中1例ではCTで病変を指摘されなかった.したがって,自験例におけるIADI診断に対するCTの精度は,感度80%,特異度98%,陰性適中率99%,陽性適中率50%であった.AS群における18例(7.7%)で術後リンパ節もしくは遠隔転移を認めたが,同側副腎の孤発性再発は1例も認めなかった.<br> (結論) 腎癌による同側副腎浸潤または転移はまれであり,特に副腎温存術式施行後の同側孤発性転移の頻度は非常に低い,また,同側副腎浸潤または転移例の予後が極めて不良なことから,同側副腎摘除の治療的意義は限定的であることが示唆される.<br>

(Purpose) The aim of this study is to analyze the incidence of involvement of ipsilateral adrenal gland from renal cell carcinoma and assess the actual significance of ipsilateral adrenalectomy at nephrectomy.<br> (Patients and methods) From 1981 to 2007, 588 patients were diagnosed as having renal cell carcinoma pathologically at our institution. Of those patients, we retrospectively reviewed the clinicopathologic data in the 426 renal cell carcinoma patients who were eligible for evaluation. Of the 426 patients, 193 (AD group) and the remaining 233 (AS group) underwent radical or partial nephrectomy with or without adrenalectomy, respectively.<br> (Results) Five patients (2.6%) of AD group had adrenal involvement and all of them presented T4 and/or M1 disease. The three patients presented direct involvement of adrenal gland, while metastasis in the remaining 2. All the 5 patients had disease progression after surgery and 4 of them died of disease. The remaining one patient, in whom interferon showed a remarkable response, has been alive with disease for 31 months. The ipsilateral adrenal gland was abnormal on preoperative computed tomography (CT) in 8 patients (1.8%), of whom, 4 had adrenal involvement. One of the five adrenal involvements was overlooked by CT. Thus, in this study, CT showed 80% sensitivity, 98% specificity, 99% negative predictive value and 50% positive predictive value. The 18 patients (7.7%) in AS group later developed nodal and/or visceral metastasis, while no solitary ipsilateral adrenal recurrence was observed in this group.<br> (Conclusions) Ipsilateral adrenal involvement from renal cell carcinoma is rare, especially after the adrenal-sparing surgery. It is concluded that concomitant adrenalectomy appears to give a very limited therapeutic benefit in this study.<br>

Journal

  • The Japanese Journal of Urology

    The Japanese Journal of Urology 101(4), 592-596, 2010-05-20

    The Japanese Urological Association

References:  17

Codes

  • NII Article ID (NAID)
    110007619527
  • NII NACSIS-CAT ID (NCID)
    AN00196577
  • Text Lang
    JPN
  • Article Type
    ART
  • ISSN
    00215287
  • NDL Article ID
    10676802
  • NDL Source Classification
    ZS39(科学技術--医学--皮膚科学・泌尿器科学)
  • NDL Call No.
    Z19-203
  • Data Source
    CJP  NDL  NII-ELS  J-STAGE 
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