Clinical study on recurrence in bladder cancer patients undergoing total cystectomy--statistical analysis of factors related to recurrence

Abstract

1981年から1995年迄の間に膀胱全摘除術が行われた原発性膀胱移行上皮癌77例を対象にした.77例中27例に再発が認められ, 1, 2, 3年非再発率はおのおの75.3, 64.9, 63.3%であった.手術後再発迄の期間は平均12.1ヵ月で, 27例中25例が2年以内に再発した.初回再発部位として27例中, 骨髄内再発のみ6例, 遠隔転移のみ18例, 骨盤内再発及び遠隔転移1例尿道再発2例であった.遠隔臓器転移の部位としては骨が最も多く, ついで肺の順であった.全体の原因特異的生存率は1年84.7%, 3年71.1%, 5年65.6%であり, 27例中25例が膀胱癌死した.再発及び予後との関係について単変量及びCoxの比例ハザードモデルを用いた多変量解析を行った.深達度, リンパ管侵襲, 静脈侵襲, 浸潤増殖様式, 所属リンパ節転移は, 単変量解析では有意な再発危険因子及び予後因子であったが, 多変量解析ではリンパ管侵襲のみが有意な再発及び予後に対する危険因子であった

A clinico-pathological study was performed retrospectively for 77 patients undergoing total cystectomy for primary transitional cell carcinoma of the urinary bladder between 1981 and 1995 to clarify the mode of recurrence, the risk factors which may affect recurrence following cystectomy and prognostic factors. Postoperative recurrence was recognized in 27 (35.1%) out of 77 patients and the one-, two- and three-year non-recurrent rates by the Kaplan-Meier method were 75.3, 64.9% and 63.3%, respectively. The duration from cystectomy to recurrence was 1 to 102 months with a mean of 12.1 months, and approximately 92.6% of recurrence occurred within two years. Among 27 patients with recurrence, pelvic recurrence, distant metastasis, both of them and urethral recurrence were recognized in 6 (22.2%), 18 (66.7%), 1 (3.7%) and 2 (7.4%), respectively as the first site of recurrence. The overall one-, three- and five-year cause-specific survival rates of the 77 patients were 84.7, 71.1% and 65.6%, respectively. Of the 27 patients with recurrence, 25 (92.6%) died of bladder cancer. Of the factors related to recurrence or prognosis, pathological stage, lymphatic invasion, venous invasion, type of infiltration and lymph node metastasis but not pathological grade or adjunctive chemotherapy were significant risk factors for recurrence and prognostic factors in univariate analysis. However, lymphatic invasion was the only significant risk factor for recurrence and prognosis in multivariate analysis using Cox's proportional hazard model.