Grade 3表在性膀胱癌の治療法の選択に関する検討

Abstract

1994年12月迄の18年間に治療したG3で表在性(pTa, pTl)の膀胱癌90症例を対象に臨床的に検討を行った. 1)表在性でG3の腫瘍の症例の予後に影響する因子は年齢と腫瘍の増殖様式であった.即ち, 67歳以上の症例は67例未満に比較して有意に予後不良であり, 又, 発育様式が非乳頭状広基注の腫瘍は他のどのタイプの腫瘍に比較しても有意に予後不良であった. 2)全症例のうち膀胱癌死症例は11例であり, 多発性で非乳頭状広基性の腫瘍をもつ症例が多かった.これらの症例に対しては膀胱温存療法よりも膀胱全摘除術を選択するべきであると思われた

Between January, 1977 and December, 1994, 90 patients with grade 3 (G3) superficial bladder cancer were treated at Yokohama City University Hospital, Yokohama Municipal Hospital and Kanagawa Cancer Center. These patients were clinically observed. The prognostic factors of the patients with G3 superficial bladder tumors were age and growth pattern of tumors. Patients older than 67 showed significantly poor survival compared with younger patients (p < 0.01). Patients with non-papillary sessile tumors showed significantly poor survival compared with the other groups (p < 0.05). The five-year survival rate of the patients with G3 superficial tumors who were treated by total cystectomy was 75%, whereas all the patients who were treated by bladder preservation therapy died within 4 years, the difference being significant (p < 0.05). Eleven patients with G3 superficial bladder tumors died of cancer, and most of these patients had multiple and non-papillary sessile tumors. These findings suggest that the patients with G3 superficial tumors, which are non-papillary sessile tumors, should be treated by radical cystectomy.