膀胱癌全摘除症例の臨床的検討

Abstract

根治的膀胱全摘除術及び骨盤リンパ節郭清を施行した96例(男83例, 女13例)を対象に, 治療生成及び予後因子について検討した.その結果, 疾患特異的生存率は3年が81.7%, 5年及び7年は71.2%と良好で, 生存率に有意差を認めたのは6因子(術前水腎症, 術前クレアチニンクリアランス値, 組織深達度, リンパ節転移, 静脈侵襲, リンパ管侵襲)であった.術前に水腎症を呈した症例と静脈侵襲を認めた症例では5年生存率が有意に低かった.水腎症のある症例では組織深達度がpT3以上及びリンパ節転移陽性が多く, ない症例ではpT2以下が多かった.又, 静脈侵襲を認めた症例では, adjuvant療法を施行した症例の方が施行しない症例に比べて予後が良好であった

A retrospective clinicopathological study was performed on 96 bladder cancer patients who underwent radical cystectomy and pelvic lymphadenectomy at Aichi Cancer Center between April 1994 and July 2004. The follow-up period ranged from 4 to 109 months, with a mean of 39.1 months. The overall cancer-specific survival rates at 3, 5 and 7 years were 81.7%, 71.2% and 71.2%, respectively. The 5-year survival rate according to pathological stage was 97.3% for pT1 or lower, 66.4% for pT2, 47.6% for pT3, and 25.4% for pT4. Univariate analysis demonstrated the prognostic significance of pathological stage (p < 0.001), lymph node metastasis (p = 0.001), venous invasion (p < 0.001), lymphatic invasion (p = 0.010), preoperative creatinine clearance (p = 0.001) and preoperative hydronephrosis (p < 0.001). Multivariate analysis revealed strong independent correlations of venous invasion (p = 0.040) and preoperative hydronephrosis (p = 0.016) with prognosis.