膀胱癌術後に発生した上部尿路上皮癌の臨床的検討

Abstract

手術後2年以上経過観察した初発原発性膀胱移行上皮癌110例(15～88歳)を対象に, 膀胱癌術後に発生した上部尿路上皮癌の発生起源, 危険因子について検討した.4例(3.6%)に上部尿路上皮癌が続発し, 先行した膀胱癌と続発した上部尿路上皮癌は病理組織学的にほぼ一致していた.続発性上部尿路上皮癌の危険因子としては, 高異型度, 多発性癌, 再発の繰り返し, 職業性膀胱癌, 上皮内癌(CIS)の存在, VURの存在, 膀胱壁内尿管への浸潤などが考えられた

A total of 110 patients were treated with primary transitional cell carcinoma (TCC) of the urinary bladder from 1990 to 2000. During the follow-up period, which was for at least two years, four patients (3.6 percent) had subsequent upper urothelial cancer at an average of 61.5 months after initial treatment of the bladder tumor. Two of the four patients received transurethral resection several times, and the remaining two patients underwent radical cystectomy for the initial bladder tumor. The histopathological findings of subsequent upper urothelial cancer were almost the same as those for the initial bladder tumor. One patient had accompanying carcinoma in situ (CIS) and the other had adenocarcinoma with TCC. Since 1) high grade, 2) multiple, 3) recurrent and 4) occupational bladder tumors, 5) concomitant CIS, 6) vesicoureteral reflux and 7) tumor invasion of the intravesical ureters have been reported to be risk factors for developing subsequent upper urothelial cancer, patients with bladder tumors who have these risk factors should be followed-up closely.