臨床泌尿器科60巻8号

2006年07月発行

特集 泌尿器科臨床の難問を解く―EBMを考慮した解説

転移を伴う腎癌症例の腎摘除術の適応

著者： 小原航¹ 藤岡知昭¹

所属機関： ¹岩手医科大学泌尿器科

ページ範囲：P.529 - P.534

文献概要

要旨　転移を伴う腎細胞癌症例の腎摘除術の適応については以前から意見の分かれるところである。転移性腎癌の予後予測因子，腎摘除術自体の効果と危険性，腎摘除術によるQOL（quality of life）の向上，腎摘除術による免疫療法の有効性の向上，腎摘除術による生存率の改善といった観点から腎摘除術の適応についてEBMに基づき検討した。現状では，performance status（PS）が良好で，転移巣の摘除が可能，術後の免疫療法の効果が期待できる症例に対しては積極的適応と考えられる。一方，PS不良や予後不良因子を有する症例においては腎摘除術が予後に寄与する可能性は少なく，免疫療法を中心とした全身療法が適応になると考えられる。

参考文献

1）Novick AC and Campbell SC：Renal tumours. In：Campbell's Urology. edited by Walsh PC, et al. WB Saunders, Philadelphia, pp2672-2772, 2002

2）Figlin RA：Renal cell carcinoma：management of advanced disease. J Urol 161：381-386, 1999

3）Motzer RJ, Mazumdar M, Bacik J, et al：Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma. J Clin Oncol 17：2530-2540, 1999

4）Motzer RJ, Bacik J, Schwartz LH, et al：Prognostic factors for survival in previously treated patients with metastatic renal cell carcinoma. J Clin Oncol 22：454-463, 2004

5）Wagner JR, Walther MM, Linehan WM, et al：Interleukin-2 based immunotherapy for metastatic renal cell carcinoma with the kidney in place. J Urol 162：43-45, 1999

6）Walther MM, Yang JC, Pass HI, et al：Cytoreductive surgery before high dose Interleukin-2 based therapy in patients with metastatic renal cell carcinoma. J Urol 158：1675-1678, 1997

7）Lokich J：Spontaneous regression of metastatic renal cancer. Case report and literature review. Am J Clin Oncol 20：416-418, 1997

8）Thoroddsen A, Gudbjartssson T, Geirsson G, et al：Spontaneous regression of pleural metastases after nephrectomy for renal cell carcinoma―a histologically verified case with nine-year follow-up. Scand J Urol Nephrol 36：396-398, 2002

9）Kirkali Z, Tuzel E and Mungan MU：Recent advantage in kidney cancer and metastatic disease. BJU Int 88：818-824, 2001

10）Taub DA, Miller DC, Cowan JA, et al：Impact of surgical volume on mortality and length of stay after nephrectomy. Urology 63：862-867, 2004

11）Thoroddsen A, Gudbjartsson T, Jonson E, et al：Operative mortality after nephrectomy for renal cell carcinoma. Scand J Urol Nephrol 37：507-511, 2003

12）Slaton JW, Perrotte P and Balbay MD：Reassessment of the selection criteria for cytoreductive nephrectomy in patients with metastatic renal cell carcinoma. J Urol 163（Suppl 4）：79, 2000

13）Leibovich BC, Han KR, Bui MH, et al：Scoring algorithm to predict survival after nephrectomy and immunotherapy in patients with metastatic renal cell carcinoma：a strakmltification tool for prospective clinical trials. Cancer 98：2566-2575, 2003

14）Munro NP, Woodhams S, Nawrocki JD, et al：The role of transarterial embolization in the treatment of renal cell carcinoma. BJU Int 92：240-244, 2003

15）Ritchie AW and Chisholm GD：The natural history of renal cell carcinoma. Semin Oncol 10：390-400, 1983

16）Walter MM, et al：Hypercalcemia in patients with metastatic renal cell carcinoma：Effect of nephrectomy and metabolic evaluation. J Urol 158：733-739, 1997

17）Mosharafa A, Koch M, Shalhav A, et al：Nephrectomy for metastatic renal cell carcinoma：Indiana University experience. Urology 62：636-640, 2003

18）Bennett RT, Lerner SE, Taub HC, et al：Cytoreductive surgery for stage Ⅳ renal cell carcinoma. J Urol 154：32-34, 1995

19）Rackley R, Novick A, Klein E, et al：The impact of adjuvant nephrectomy on multimodality treatment of metastatic renal cell carcinoma. J Urol 152：1399-1403, 1994

20）Wolf JS, Aronson FR, Small EJ, et al：Nephrectomy for metastatic renal cell carcinoma：a component of systemic treatment regimens. J Surg Oncol 55：7-13, 1994

21）Fallick ML, McDermott DF, LaRock D, et al：Nephrectomy before interleukin-2 therapy for patients with metastatic renal cell carcinoma. J Urol 158：1691-1695, 1997

22）Figlin RA, Pierce WC, Kaboo R, et al：Treatment of metastatic renal cell carcinoma with nephrectomy, interleukin-2 and cytokine-primed or CD8（＋）selected tumor infiltrating lymphocytes from primary tumor. J Urol 158：740-745, 1997

23）Levy DA, Swanson DA, Slaton JW, et al：Timely delivery of biological therapy after cytoreductive nephrectomy in carefully selected patients with metastatic renal cell carcinoma. J Urol 159：1168-1172, 1998

24）Wood CG, Huber N, Madsen L, et al：Clinical variables that predict survival following cytoreductive nephrectomy for metastatic renal cell carcinoma. J Urol 165（5 Suppl）：184 A, 2001

25）Han KR, Pantuck AJ, Bui MH, et al：Number of metastatic sites rather than location dictates overall survival of patients with node-negative metastatic renal cell carcinoma. Urology 61：314-319, 2003

26）Pantuck AJ, Zisman A, Dorey F, et al：Renal cell carcinoma with retroperitoneal lymph nodes：impact on survival and benefits of immunotherapy. Cancer 97：2995-3002, 2003

27）Flanigan RC, Salmon SE, Blumenstein BA, et al：Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer. N Engl J Med 345：1655-1659, 2001

28）Mickisch GH, Garin A, van Poppel H, et al：Radical nephrectomy plus interferon-alfa-based immunotherapy compared with interferon alfa alone in metastatic renal-cell carcinoma：a randomised trial. Lancet 358：966-970, 2001

29）Flanigan RC, Mickisch G, Sylvester R, et al：Cytoreductive nephrectomy in patients with metastatic renal cancer：a combined analysis. J Urol 171：1071-1076, 2004

30）Mickisch GH and Mattes RH：Combination of surgery and immunotherapy in metastatic renal cell carcinoma. World J Urol 23：191-195, 2005