Ishikura K, Yoshida N, Hasegawa M, Nomura K, Okamoto T, Tanji S, Fujioka T, Ohhori T, Kubo T
Department of Urology, Iwate Medical University.
Hinyokika Kiyo. 1994 May;40(5):373-7.
We studied 15 patients with renal cell carcinoma invading adjacent organs (stage T4) between January 1980 and December 1991. Such invasion was four times more frequent in males than in females. The patients were between 41 and 78 years old, with a mean age of 63.9 years. The tumor was on the right side in 4 cases, and on the left side in 11 cases. Six patients (40%) presented with flank pain. The pancreas was the organ involved most frequently. Eleven patients had regional lymph node involvement or distant metastasis. Most patients had an increased erythrocyte sedimentation rate (ESR), elevated alpha-2 globulin levels, and positivity for c-reactive protein (CRP). In 6 patients, nephrectomy was extended to the abdominal or retroperitoneal structures that seemed to be invaded by tumor. Patients with T2 or T3 tumor had a significantly longer overall survival than patients with a T4 tumor. However, there was no significant difference in survival between T2/T3 tumors and T4 tumors in nephrectomized patients. Two patients who survived longer than 3 years showed no abnormalities of ESR, alpha-2 globulin and CRP. They also had no nodal or distant metastases, and had a good initial performance status. These findings suggest that extended local resection can improve the survival and quality of life for selected patients with T4 tumors.
我们研究了1980年1月至1991年12月期间15例肾细胞癌侵犯邻近器官（T4期）的患者。这种侵犯在男性中的发生率是女性的4倍。患者年龄在41岁至78岁之间，平均年龄为63.9岁。肿瘤位于右侧4例，左侧11例。6例患者（40%）出现胁腹痛。胰腺是最常受累的器官。11例患者有区域淋巴结受累或远处转移。大多数患者红细胞沉降率（ESR）升高、α-2球蛋白水平升高以及C反应蛋白（CRP）呈阳性。6例患者的肾切除术扩展至似乎被肿瘤侵犯的腹部或腹膜后结构。T2或T3期肿瘤患者的总生存期明显长于T4期肿瘤患者。然而，在接受肾切除术的患者中，T2/T3期肿瘤和T4期肿瘤患者的生存期没有显著差异。两名存活超过3年的患者ESR、α-2球蛋白和CRP均无异常。他们也没有淋巴结或远处转移，且初始身体状况良好。这些发现表明，扩大局部切除术可以改善部分T4期肿瘤患者的生存期和生活质量。
