膀胱癌に関する研究 第2編: 膀胱癌患者244例の臨床的観察 (浸潤度および遠隔成績を中心として)

Abstract

The purpose of this report is to present the results of clin i cal observations made on 244 cases of urinary bladder cancer treated at the Department of Urology of Kyoto University Hospital during the period from 1954 to 1964 (Table 1). I Symptoms 1) Some difference on initial symptoms was observed between infiltrating cancer and noninfiltrating cancer. In patien t s with infiltraitng cancer, the initial symptoms were asymptomatic gross hematuria in 21.1%, gross hematuria with vesical irritability in 29.6% and vesical irritability without gross hematuria in 33.8%, while in patients with non-infiltrating cancer, asymptomatic gross hematuria, gross hematuria with vesical irritability and vesical irritability without gross hematuria were stated in 71.1%, 15.2% and 13.1%, respectively, as the initial symptoms. It is noteworthy that asymtomatic gross hematuria is most frequently seen in non-infiltrating cancer but less frequently noted in infiltrating cancer in where larger proportion of patients had only vesical irritability without any gross hematuria (Table 2). 2) The duration between the onset of initial symptom and ho s pital visit were less than 3 months in 31.9% of patients, 3 to 6 months in 16.4%, 6 to 12 months in 18.8%, 1 to 2 years in 15.0% and over 2 years in 17.9% (Table 3). 3) The duration between the onset and h ospital visit was not invariably parallel to the stage of infiltration. This was evident from the facts that 15.5% of patients among those visited hospital within 3 months from the onset showed the infiltration at stage C or D, while 31.2% of patients among those visited hospital 2 years or more after the onset demonstr ated that the infiltration stayed within stage 0 or A (Table 4). II Findings of Clinical Exa m i n a t i o n s 1) Although a trend of increased erythrocyte sed i m entation rate was observed in patients with stage C or D, no difference on the rate was noted between stage 0 or A group and stage B group (Fig. 2). 2) Relationship between erythrocyte count and degree of infiltration showed markedly frequent occurrence of decreased erythrocyte count in patients with stage C or D. Howev er, patients with stage 0 or A and stage B also showed decreased erythrocyte count in not infrequent cases (Fig. 3). Similar trends w ere observed on hemoglobin content (Fig. 4). 3) In 41.8% of patients with stage C or D, neutrophilic l e u kocytosis was demonstrated, while in 21.8% of patients with stage 0 or A and in 34.4% of patients with stage B (Table 5). 4) In 24.9% of patients with stage C or D, hypoproteinemia was demonstrated, while i n 16.7% of patients with stage 0 or A and in 18.7% of patients with stage B (Table 6). Decreased albumin and increased globulin especially gamma-globulin were dem o nstrated among the patients with hypoproteinemia by the fractionation of plasma proteins based upon electrophoresis (Fig. 5) 5) In 30.3% of p a tients with stage C or D, hyperazotemia was demonstrated (Table 7). 6) Serum electrolytes were within almost normal ranges in almost all cases. 7) C-reactive protein was positive in 64.9% of patients with stage C or D, while in 42.9% of patients with stage B and in 5.3% of patients with stage 0 or A. C-reactive protein seems to be an informative test to evaluate the degree of infiltration, even though many other factors will concern the C-reactive protein (Table 8). 8) Intravenous pyelography disclosed m ore frequent abnormalities in patients with more advanced infiltrations. Namely, in 6.2% of patients with stage 0 or A, in 48.3% of patients with stage B and in 77.0% of stage C or D, respectively (Table 9). III Results of Long Term Observatio n 1) In 30 cases who were given no essential treatmen t with various reasons, the 1, 3 and 5 years survival rates from the onset of initial symptoms were 69.1%, 17.5% and 8.7%, respectively (Fig. 7). In 32 cases who were given no essential treatment, the 6 months, 1, 2, and 3 years survival rates from diagnosis were 13.9%, 9.9%, 5% and 0%, respectively (Fig. 8). 2) In 34 cases treated by fulgulation, the 3 and 5 years survival ra t e s were 83.5% and 73.6%, respectively (Fig. 9). 3) In 22 cases treated by local excision of the tumor, the 3 and 5 years survival rates were 87.5% (Fig. 10). 4) In 66 cases treated by partial cystectomy, the 3 and 5 years survival rates were 61.0% and 56.0%. The 5 years relative survival rate was 68.3%. The 3 and 5 years survival rates of the patients with stage 0 or A were 81.4% ; stage B, 28.8%, 14.5%; stage C or D, 36.7%, 19.7%, respectively (Table 10, Fig. 11). 5) In 70 cases treated by total c y stectomy, the 3 and 5 years survival rates were 39.4% and 26.2%. The 5 years relative survival rate was 30.8%. The 5 years survival rates of the patients with s t a ge 0 or A, stage B and stage C or D were 53.1%, 13.7% and 11.0%, respectively. In patients treated by total cystectomy with urinary diversion by Bricker's operation, bilateral ureterocutaneostomy and rectal bladder, the 5 years survival rates were 59.5%, 28.8% and 0%, respectively (Table 12, Fig. 11). 6) The survival rates of the patie n ts treated by tele oCo radiation after partial cystectomy were better than groups given no radiation.