Grade 3 Ta-1表在性膀胱癌に対する膀胱温存治療

Abstract

初発Grade 3 Ta-1表在性膀胱癌の治療成績を後方視的に解析し, 診断及び治療における問題点と膀胱温存の立場から治療指針について考察した.1995～2003年に経験した膀胱移行上皮癌初発症例69例(男61例, 女8例, 平均66.2±9.5歳)を対象に臨床病理学的検討を行った.病理組織診断はTaが7例, T1が62例, CIS随伴が15例, CIS非随伴が54例であった.TURBT術後の初期治療として無補助治療が16例, BCG注入療法が35例, 抗癌剤注入療法が6例であった.G3 T1でも大径腫瘍や微小浸潤など悪性進展が疑われた症例は全身化学療法が5例に行われ, 放射線併用動注化学療法が2例に施行された.広範囲のCIS随伴や微小浸潤例に対しては膀胱全摘が5例に行われた.69症例の観察期間の中央値は52ヵ月で, その成績は膀胱内再発は17例, 進展9例で, そのうち癌死が8例, 他因死が7例, 5年非再発率は66%, 5年非進展率は82%, 5年全生存率は76%であった.BCG療法への抵抗や早期再発など悪性進展のリスクが高い症例に対しては浸潤性膀胱癌に準じて膀胱全摘術も視野に入れた治療を検討すべきであると考えられた

We retrospectively investigated the therapeutic outcomes of our series of 7 Ta and 62 T1 bladder cancers with grade 3 (G3) malignancy in 61 men and 8 women having a mean age of 66.2 years. Following transurethral resection of bladder tumor (TURBT), 35 and 6 patients received intravesical instillations of bacillus Calmette-Guerin (BCG) and anthracycline-derivants, respectively, whereas 15 received no adjuvant therapy. Five and 2 patients received systemic and local chemotherapy with irradiation, respectively, and six underwent radical cystectomy for invasive potential. The 5-year nonrecurrence, progression-free, and overall (cancer-specific) survival rates were 66, 82%, and 76 (88%), respectively, after a median follow-up of 52 months. The 5-year non-recurrence rates were 24% in non-adjuvant, 85% in BCG, 0% in anthracycline-derivants, 65% in systemic and local chemoradiation therapy, and 68% in cystectomy. The 5-year progression-free and overall (cancer-specific) survival rates of the patients treated with BCG instillation were 91% and 94 (100)%. There were no significant differences in the 5-year non-recurrence and progression-free rates between 12 patients with carcinoma in situ (CIS) and 23 patients without CIS. Complete TUR of all visible tumors and a reliable histopathological diagnosis of appropriate specimens bearing the muscle layer are mandatory for assessment of recurrence. G3 Ta-1 bladder cancers and CIS showed a high risk of recurrence, and required aggressive treatment. Since BCG therapy following TURBT significantly reduced the risk of recurrence and progression, adjuvant BCG therapy is considered to be the most promising initial conservative treatment for G3 Ta-1 bladder cancers.