膀胱全摘術施行症例の臨床的検討

Abstract

膀胱全摘を施行した67例について検討した。1)病理学的深達度別に予後を検討すると, pTis, pTa, pT1aでは癌死は認めなかったが, pT0, pT1b, pT2, pT3a, pT3b, pT4ではそれぞれ, 2/4, 2/12, 2/9, 4/14, 4/10, 5/7の症例に癌死を認め, 術後2年以内に集中していた。pT2以下の36例とpt3以上の31例を比較すると, 前者の5年生存率は81%, 後者のそれは56%であり, 両群間には統計学的有意差を認めた。2)異型度別には, G1では癌死を認めず, G2, G3ではそれぞれ3/12, 8/34の症例が癌死していた。3) pN0, pN1ではそれぞれ6/47, 1/3の癌死を認め, pN≧2の症例は11例すべてが術後2年までに癌死していた

We assessed the treatment outcome of total cystectomy for 67 patients with bladder cancer treated at Asahikawa Medical College Hospital between 1977 and 1991. The analyses of cause-specific 5-year survival rates by pathological stage (pT) and grade revealed a lower survival rate for higher stage, higher grade and non-transitional cell carcinomas. The condition of lymph node metastases (pN) was also correlated to the survival rate. Significant differences were observed between the survival rates of the patients with pT or = 3, and the patients with pNO and pN > or = 2. The cancer deaths were mainly caused by distant metastases. Preoperative irradiation showed prognostic advantage in the patients who had acquired down-staging by this treatment, and postoperative systemic chemotherapy also improved the prognosis in the patients with pT > or = 3.