局所浸潤膀胱癌に対する放射線及び化学療法を主体とした膀胱温存療法の長期予後について

Abstract

膀胱温存療法が施行された局所浸潤膀胱癌54症例を対象に検討した. 1)局所浸潤膀胱癌に対する膀胱温存療法施行症例は膀胱全摘除術施行症例と比較して有意に高齢者に多く施行されていた.又, cause-specific survivalでは有意に予後不良であった. 2)局所浸潤膀胱に対する膀胱温存療法施行症例の予後を不良としている背景因子は単変量解析では腫瘍の大きさ, 水腎症の有無, 腫瘍のgrade, PSの4項目であり, 多変量解析では腫瘍のgradeに最も重みが存在した. 3)5年以上生存例は17例であったが, PS 0, 1が78%であった.又, 5年から10年の間に癌死した症例が4例存在し, 他に癌あり生存中が2例存在し, これらは全てG3症例であった

The prognoses and prognostic factors of the 54 patients with locally invasive bladder cancer who underwent bladder preservation therapy at Yokohama City University Hospital between 1977 and 1995 were analyzed statistically. The therapeutic modalities of bladder preservation were mainly radiation or chemotherapy. The prognosis for the patients who underwent bladder preservation therapy was worse than that for the patients who underwent total cystectomy. The prognostic factors of these patients were size and grade of tumor, presence of hydronephrosis and performance status (PS) of the patients by univariate analysis. Tumor grade was the most predictable prognostic factor using multivariate analysis. Only 17 patients survived more than 5 years after treatment; 78% of the survivors had good PS (0 or 1). Five of them died of cancer and two patients were alive with cancer. All of them had G3 tumors. These results suggest that patients with locally invasive G2 tumor could be candidates for bladder preservation therapy and patients who underwent bladder preservation therapy should be evaluated at 10 years post-therapy.