表在性膀胱癌Grade-up症例の検討

Abstract

1993年12月迄の17年間に初診で受診した表在性でG1或いはG2の腫瘍は249例で, うちG3にgrade-upした症例は16例であった.これらの症例を対象に臨床的検討を行った. 1)Grade-up腫瘍は非乳頭状広基性で浸潤性の腫瘍として再発することが多く, 再発時に尿細胞診が陽性になることが多かった. 2)Grade-up腫瘍は初回の再発が短期間であり, 多発性の腫瘍再発等で放射線療法等を施行されるケースが多かった. 3)Grade-up症例の治療は膀胱全摘除術を受けた10例の5年生存率が72%であり, 全体症例の5年生存率とほぼ同等であるが, 膀胱温存療法を受けた6例は6年以内に全て癌死した

Between January 1977 and December 1993, 249 patients with grade 1 or grade 2 superficial bladder cancer were initially treated at Yokohama City University Hospital. Eighty-six patients (33%) had recurrent tumors after initial resection, and sixteen recurrent cases were so-called grade-up tumors that is, grade 3 originating from grade 1 or grade 2 tumor. The morphology of the grade-up tumors mostly showed non-papillary and invasive type. Positivity for urinary cytology of grade-up tumors was 88%. The five-year survival rate of the patients with grade-up tumors was 85% after initial resection of grade-up patients and 48% after treatment of grade-up tumors. The five-year survival rate of the patients with grade-up tumors who were treated by total cystectomy was 72%, whereas that in the patients who were treated by bladder preservation therapy showed a 13% five-year survival rate and all of the six patients died of cancer during the six-year follow-up period. These findings suggest that patients who have grade up tumors should be treated by radical treatment with radical cystectomy.