Treatment and prognosis of renal cell carcinoma extending into the inferior vena cava

1994年12月迄の11年間に, 当科において経験した下大静脈腫瘍血栓を伴う腎細胞癌症例9例に対し, 手術成績を中心に臨床的検討を行った.1985年以前の症例に比し5年生存率で23.4%も改善した.これは早期癌症例の増加だけでなく, 病期IIIの治療成績の改善も寄与していたし, 術後のInterferon投与例が多かった為かもしれない
Out of 173 patients with renal cell carcinoma diagnosed at our department between January 1984 and December 1994, 9 (5.2%) had an inferior vena caval tumor thrombus. They consisted of 6 men and 3 women between 43 and 74 years old with a mean age of 59.8 years. The tumors were on the right and left sides in 5 and 4 patients, respectively. According to the Novick's classification, 2, 1, 4 and 2 patients had level 1 (perirenal), level 2 (infrahepatic), level 3 (intrahepatic) and level 4 (suprahepatic) tumors, respectively. Five patients without distant metastases underwent nephrectomy and removal of the vena caval tumor thrombus. Although renal tumors and vena caval tumor thrombi were completely resected in all of the 5, 4 died of disease within 3 years. Only 1 patient without tumor invasion into the inferior vena caval wall survived over 5 years without disease. Since surgical treatment is the sole radical method for renal cell carcinoma, surgery is recommended for the patients even with a vena caval tumor thrombus unless there are metastases.