免疫治療中止後も長期生存中の腎細胞癌患者

Multiple, late metastatic recurrence of renal cell carcinoma：A case report with long survival

　症例は80歳，女性。60歳時，左腎細胞癌の診断で根治的腎摘除術を施行された。以後14年間再発を認めず経過したが，74歳時に膵転移が出現，IFN-αを8か月間投与したところ増大があり，PD（progressive disease）の診断でIL-2を2か月間投与し，以後経過観察とした。その後も後腹膜転移巣は徐々に増大，76歳時に甲状腺転移が出現，術後20年の現在もADL（activity of daily living）の低下はなく生存中である。転移性腎細胞癌患者の中には，積極的加療でなくともある程度の制癌状態が誘導される治療が有効である可能性が示唆された。

　A case of 80-year-old woman with multiple metastatic recurrence of renal cell carcinoma（RCC） was described. She had undergone left nephrectomy for renal cell carcinoma 20 years ago. At 14 years after operation, dynamic CT showed hypervascular masses in pancreas, and a diagnosis of metastatic RCC was made. She had undergone cytokine therapies including IFN-α and IL-2, but the disease was progressive, new nodal and thyroidal metastasis appeared at 15 and 16 years after operation, respectively. The metastatic lesions were growing slowly, but the patient has been well for 6 years after the onset of metastases. Although most patients with late recurrence of RCC are considered to be with widespread metastases when diagnosed, it is suggested that‘tumor dormancy’could be obtained by conservative therapy with cytokines in selective cases.