福井医科大学泌尿器科開設後10年間(1984年6月～1994年9月)の膀胱全摘除術治療成績

Abstract

根治的膀胱全摘除術を施行された原発性膀胱癌63例の治療成績に関して検討した.平均年齢は68歳, 男女比は4.7:1であった. 1)組織型は扁平上皮癌, 腺癌をおのおの2例に認めた以外は全例移行上皮癌で, 膀胱壁内腫瘍(pTa～pT3a)を37例, 壁外浸潤腫瘍(pT3b～4)を26例に認めた.膀胱壁内リンパ管侵襲を60%に, 静脈侵襲を37%に認めた.リンパ節転移は10例(16%)に, 遠隔転移は3例(5%)に認められた. 2)全症例の実測5年生存率は54%で, 深達度が予後と有意に関連していた

The treatment outcome was evaluated in 63 patients with bladder cancer more than 2 years after cystectomy. Cisplatin-based combination chemotherapies were given to 40 patients after the operation as an adjuvant therapy and two patients with T4 or N2 bladder cancer received chemotherapy before the operation as a neoadjuvant therapy. The extent of infiltration of the removed tumors was pTa in 5, pT1 in 18, pT2 in 8, pT3a in 6, pT3b in 17, and pT4 in 9 cases. Regional lymph node metastases were present in 10 cases (16%). Nineteen patients died of tumor recurrences. The 5-year acturial survival rates at each stage were 60% for stage pTa, 78% for stage pT1, 63% for stage pT2, 83% for stage pT3a, 33% for stage pT3b and 38% for stage pT4, respectively. A significant difference (p < 0.05) in survival curve was observed between pT3a and pT3b. The prognosis of patients with tumors extending beyond the bladder muscles is extremely unfavourable, with the exception of bladder cancers infiltrating the neighboring organ (pT4a), the removal of which may result in lasting survival in a part of the cases. Effective adjuvant treatment is required for patients with bladder tumors penetrating the bladder wall.