G3表在性膀胱腫瘍の再発および進展に関する臨床的検討

Abstract

1)G3表在性膀胱腫瘍41例の内, 再発が認められたのは18例であった.全体の初回治療後の1, 3, 5年の非再発率はそれぞれ, 77.0, 44.6, 35.6%であった.また, pTaとpT1症例の比較では1, 3, 5年の非再発率はそれぞれ, pTa症例は100, 57.7, 38.5%であるのに対し, pT1の症例は60.4, 36.2, 36.2%で非再発率に関して有意差を認めた. 2)初回治療の臨床的及び病理学的因子の相互関係として, 「肉眼的血尿」と「深達度」の間で有意な相関を認めた. 3)再発に関する臨床的及び病理学的因子を多変量解析を用いて検討したところ, 膀胱刺激症状, 初回治療後尿細胞診, 腫瘍数はpositive effectとして, また膀胱注入療法(BCG療法)はnegative effectとして, 有意に再発に影響をあたえることが示唆された. 4)進展についてはG3表在性膀胱腫瘍41例中6例であった.6例の進展様式は全て局所浸潤であった.転帰は6例中3例が癌死した

Forty-one patients who had grade 3, superficial, transitional cell carcinoma of the bladder were treated with transurethral resection of bladder tumor between January, 1986 and April, 1998. The clinicopathological studies were conducted on intravesical recurrence, disease progression, and prognosis using multivariate analyses. Intravesical recurrence was found in 18 patients (43.9%), and the recurrence-free rate was 77.0% for 1 year. The 3- and 5-year recurrence-free rates were 57.7% and 38.5% for patients with stage pTa disease, and 36.3% and 36.3% for patients with stawe pT1-disease. There was a significant difference between the recurrence-free rates in the patients with stage pTa disease and those with stage pT1 disease (p < 0.01). Disease progression was observed after a mean period of 14.2 months after treatment in 6 patients (14.6%) with pT1 tumors. Three of these patients died of cancer. In the multivariate analyses with clinical and pathological factors, bladder irritability, urine cytology after initial treatment, and tumor multiplicity were the factors contributing to a high risk for recurrence. Intravesical instillation with Calmette-Guerin bacillus was found to prevent recurrence. These results suggest that radical surgery should be performed in a timely manner in patients with G3-stage pT1 tumors because they have a higher risk of recurrence and progression as compared to patients with G3-stage pTa tumors.