腎孟尿管腫瘍に併発する膀胱腫瘍の臨床的検討

Abstract

北海道大学泌尿器科において1975年から1988年までに治療した腎盂尿管腫瘍76例の内, 35例(46.1%)に膀胱腫瘍の併発がみられた.膀胱腫瘍の発生が先行せるもの7例, 同時のもの17例, 続発せるもの11例であった.腎盂および上部尿管に腫瘍を有する56例中16例に同時性または続発性膀胱腫瘍を認めたのに対し, 尿管下端に腫瘍を有する17例では14例(82.4%)と高率に膀胱腫瘍の発生をみた.同時性膀胱腫瘍から更に膀胱腫瘍の発生せる8例を加えて, 全続発性膀胱腫瘍は19例あり, その内18例(95%)では腎盂尿細管腫瘍術後24ヵ月以内に続発した.膀胱腫瘍が異所性発生した15例中13例は表在性腫瘍であったのに対し, 同所性発生した4例はすべてhigh grade, high stage腫瘍であり, 予後も不良であった.膀胱腫瘍併発群の5年生存率は65.1%, 膀胱腫瘍非併発群のそれは48.6%であり, 両群間に差を認めた.続発性膀胱腫瘍群の予後は良好であったが, 先行性膀胱腫瘍群の予後は不良であった

We reviewed 76 cases of renal pelvic and ureteral cancer, admitted to our hospital between January, 1975 and December, 1988, with special reference to the occurrence of bladder cancer. Bladder cancer was associated with an upper urinary tract neoplasm in 35 of the 76 cases (46.1%), 7 with a preceding bladder cancer, 17 with a coexistent one and 11 with a subsequent one. In case of renal pelvic and upper ureteral cancer the incidence of coexistent or subsequent tumors of the bladder was 28.7% (16 of 56 patients). However, in the cases of lower ureteral cancer the incidence of these tumors was 82.4% (14 of 17 patients). This incidence was significantly higher than that in renal pelvic and upper ureteral cancer. The subsequent bladder cancer was observed in 19 patients including 8 patients who had a recurrence of the bladder cancer after the treatment for a preceding and coexistent bladder cancer. The cancer in most cases occurred within 2 years after the treatment of the upper urinary tract neoplasm. Of 19 patients who had subsequent bladder cancer 11 had primary sites in the renal pelvis and upper ureter. Another 8 patient had primary sites in the lower ureter. Four of the 8 subsequent bladder cancers in patients with lower ureteral cancer occurred just on and around the affected ureteral orifice. All these 4 tumors were high grade and high stage tumors. On the other hand, another 15 patients developed subsequent bladder cancer in a place other than the affected ureteral orifice. Of these 15 patients, 13 cases showed a low grade and low stage tumor.(ABSTRACT TRUNCATED AT 250 WORDS)