表在性のHigh grade膀胱腫瘍に対する膀胱温存療法

Abstract

表在性high gradeの膀胱腫瘍に対する膀胱温存療法の成績をretrospectiveに検討した. 1)初発表在性high grade膀胱腫瘍と診断され膀胱温存療法を選択した症例は26例で5年生存率は87.1%であった.同様に初発表在性high grade膀胱腫瘍に膀胱全摘術を施行した症例は19例で5年生存率は100%であった.両者の間には有意差は認められなかった. 2)初発時はlow gradeであったが, 再発を繰り返している内にgradeがupした膀胱腫瘍は9例で, 5年生存率は57.1%であり, 初発表在性high grade膀胱腫瘍に比して有意に生存率が低下していた

Clinical outcome of bladder preserving therapy for superficial high-grade bladder cancers (pTa-pT1b, G3) was retrospectively studied. Twenty-six patients initially received bladder preserving therapy ('preserved' group), while 19 underwent radical cystectomy as the initial treatment ('cystectomized' group). Tumor recurrence was accompanied by a progression in the tumor grade in 9 patients with low-grade tumors ('grade-up' group). The 5-year survival rate was 87% and 100% in the preserved and cystectomized groups, respectively, with no significant difference. However, the grade-up group had a significantly worse rate of 57%. Failure in bladder preserving therapy was unrelated to the size or number of tumors. Our findings suggest that bladder preserving therapy is a reasonable treatment option for superficial high-grade tumors although a careful followup is mandatory. On the other hand, radical cystectomy should be considered for recurrent, grade-up G3 tumors.