臨床整形外科53巻10号

2018年10月発行

誌上シンポジウム 原発巣別転移性骨腫瘍の治療戦略

腎癌の骨軟部転移に対する転移巣切除術

著者： 樋口貴史¹ 山本憲男¹ 林克洋¹ 武内章彦¹ 三輪真嗣¹ 五十嵐健太郎¹ 加藤仁志¹ 村上英樹¹ 土屋弘行¹

所属機関： ¹金沢大学大学院医薬保健学総合研究科整形外科

ページ範囲：P.853 - P.857

　近年，腎細胞癌の治療の進歩は目覚ましく，転移を有していても長期生存が見込めるがん種の1つとなった．また，転移性腎癌に対する転移巣切除は予後を延長することが報告され，国内外のガイドラインでも推奨されている．当院における腎癌の骨軟部転移に対する転移巣切除後の予後を解析した結果，生存期間中央値は10.6年で，これまでの報告を大きく上回るものであった．本稿では腎癌の骨軟部転移に対する転移巣切除の意義や適応，手術法などについて，当院の解析結果を基に文献的考察を加えて報告する．

参考文献

1) Motzer RJ, Bacik J, Murphy BA, et al. Interferon-alfa as a comparative treatment for clinical trials of new therapies against advanced renal cell carcinoma. J Clin Oncol 2002;20:289-96.

2) 国立がん研究センターがん情報サービス「がん登録・統計」https://ganjoho.jp/reg_stat/index.html

3) Naito S, Yamamoto N, Takayama T, et al. Prognosis of Japanese metastatic renal cell carcinoma patients in the cytokine era:a cooperative group report of 1463 patients. Eur Urol 2010;57:317-25.

4) Ljungberg B. The role of metastasectomy in renal cell carcinoma in the era of targeted therapy. Curr Urol Rep 2013;14:19-25.

5) Lin PP, Mirza AN, Lewis VO, et al. Patient survival after surgery for osseous metastases from renal cell carcinoma. J Bone Joint Surg Am 2007;89:1794-801.

):Kidney cancer Version 2．2014．

7) 日本泌尿器科学会(編)．腎癌診療ガイドライン2017年版．大阪：メディカルレビュー社；2017．

8) Motzer RJ, Tannir NM, McDermott DF, et al. Nivolumab plus Ipilimumab versus Sunitinib in advanced renal-cell carcinoma. N Engl J Med 2018;378:1277-90.

9) Katagiri H, Okada R, Takagi T, et al. New prognostic factors and scoring system for patients with skeletal metastasis. Cancer Med 2014;3:1359-67.

10) Ratasvuori M, Wedin R, Keller J, et al. Insight opinion to surgically treated metastatic bone disease:Scandinavian Sarcoma Group Skeletal Metastasis Registry report of 1195 operated skeletal metastasis. Surg Oncol 2013;22:132-8.

11) Langerhuizen DW, Janssen SJ, van der Vliet QM, et al. Metastasectomy, intralesional resection, or stabilization only in the treatment of bone metastases from renal cell carcinoma. J Surg Oncol 2016;114:237-45.

12) Piccioli A, Ventura A, Maccauro G, et al. Local adjuvants in surgical management of bone metastases. Int J Immunopathol Pharmacol 2011;24 (1 Suppl 2):129-32.

13) Higuchi T, Yamamoto N, Hayashi K, et al. The efficacy of wide resection for musculoskeletal metastatic lesions of renal cell carcinoma. Anticancer Res 2018;38:577-82.

14) Pala E, Trovarelli G, Calabrò T, et al. Survival of modern knee tumor megaprostheses:failures, functional results, and a comparative statistical analysis. Clin Orthop Relat Res 2015;473:891-9.

15) Higuchi T, Yamamoto N, Nishida H, et al. Knee joint preservation surgery in osteosarcoma using tumour-bearing bone treated with liquid nitrogen. Int Orthop 2017;41:2189-97.

16) Nishida H, Tsuchiya H, Tomita K. Re-implantation of tumour tissue treated by cryotreatment with liquid nitrogen induces anti-tumour activity against murine osteosarcoma. J Bone Joint Surg Br 2008;90:1249-55.

17) Nishida H, Shirai T, Hayashi K, et al. Cryotreatment against metastatic renal cell bone tumour reduced multiple lung metastases. Anticancer Res 2011;31:2927-30.

18) Miwa S, Takeuchi A, Shirai T, et al. Outcomes and complications of reconstruction using tumor-bearing frozen autografts in patients with metastatic bone tumors. Anticancer Res 2014;34:5569-77.

19) Ratasvuori M, Sillanpää N, Wedin R, et al. Surgery of non-spinal skeletal metastases in renal cell carcinoma:no effect of preoperative embolization? Acta Orthop 2016;87:183-8.

20) Kato S, Murakami H, Demura S, et al. Spinal metastasectomy of renal cell carcinoma:a 16-year single center experience with a minimum 3-year follow-up. J Surg Oncol 2016;113:587-92.

21) Higuchi T, Yamamoto N, Hayashi K, et al. Long-term patient survival after the surgical treatment of bone and soft-tissue metastases from renal cell carcinoma. Bone Joint J 2018;100-B:1241-8.