Grade 3表在性膀胱癌に対するBCG膀胱内注入療法の治療成績

Abstract

径尿道的膀胱腫瘍切除術を施行したGrade 3表在性膀胱癌(pTa, pT1, CIS)39例に対するBCG膀胱内注入療法の治療成績を検討した.それぞれBCG膀胱内注入治療を行った19例(BCG投与群)と同治療を拒否した15例(BCG非投与群), そしてBCG投与のprimary CIS 5例(CIS-BCG投与群)の3群分けて比較した結果, 1)再発はBCG投与群4例(21.1%), 非投与群8例(53.3%), CIS-BCG群3例(60.0%)で, 3年での再発率は各々35%, 58%, 66.7%であった.2)ProgressionはBCG投与群3例(75.0%, 癌死2例), 非投与群1例(12.5%, 癌死), CIS-BCG群2例(66.7%, 癌死1例)で, Tumor progression rateは3群間で有意差はなく, 3群間の生存率も有意差はなかった.3)BCG投与による副作用は尿意切迫・頻尿9例(37.5%), 血尿2例(8.3%), 排尿時痛5例(20.8%), 発熱4例(16.7%)で, 2例がBCG治療を中止した.その他重篤な合併症は認めなかった

To examine the incidence of recurrence, progression and survival in patients with grade 3 superficial bladder cancer after transurethral resection (TUR) and adjuvant intravesical instillation of Bacillus Calmette-Guerin (BCG), we retrospectively studied 39 patients with grade 3 superficial bladder cancer. Nineteen patients with high-grade superficial bladder cancer (pTa, pT1) and 5 patients with grade 3 carcinoma in situ (CIS) received intravesical instillation of BCG after transurethral resection of the bladder tumor (BCG group and CIS-BCG group). The Tokyo 172 strain BCG was given for 8 weeks, as a rule, in a dose of 80 mg in 40 ml of saline instilled into the bladder. As a control, 15 patients with grade 3 superficial bladder cancer who did not receive BCG therapy after TUR were compared (non-BCG group). Of the BCG group (n=19), 4 patients (21.1%) had recurrent tumor and 3 had invasive progression after BCG therapy and died as a result of tumor progression, while in the non-BCG group (n=15), 8 cases (53.3%) developed recurrence, only one case had progression and died of cancer. In the CIS-BCG group (n=5), 3 patients (60.0%) had recurrent tumor and 2 had invasive progression. Univariate analysis (Logrank test) demonstrated that tumor size and adjuvant instillation of BCG were associated with tumor recurrence except for carcinoma in situ, but tumor progression and survival did not differ significantly. Our results suggest that BCG therapy prevents grade 3 superficial bladder cancer (pT1, pTa) recurrence.