膀胱癌300例の治療成績

Abstract

男女比は3.3:1で, 平均年齢は65.3歳, 組織型別では移行上皮癌291例(97.0%), 扁平上皮癌7例(2.3%), 腺癌1例(0.3%), 未分化癌1例(0.3%)であった.Kaplan-Meier法による5年生存率は全症例で64.7%で5年生存率に影響のあった因子としては, 症状における膀胱刺激の有無, 腫瘍の大きさ, 腫瘍の形態, 異型度, 深達度および初回治療法があった.異型度別の5年生存率は, Gl:93.5%, G2:77.8%, G3:31.6%であった.深達度別の5年生存率は, Ta:94.4%, Tl:79.7%, Tis:66.7%, T2:46.1%, T3:38.5%, T4:26.6%であった.初回手術別の5年生存率は, TUR-bt:78.6%, 膀胱全摘術:51.9%, 腫瘍単純切除術:37.5%, 膀胱部分切除術:25.0%であった

From September 1973 to September 1989, 300 patients with bladder cancer were treated at the Department of Urology, Hyogo College of Medicine. They were 231 males and 69 females with an average age of 65.3 years old. The overall 5-year survival rate (Kaplan-Meier's method) was 64.7%. The 5-year survival rates were not different between male patients and female patients, or between patients with single tumor and patients with multiple tumors. Patients with vesical irritation symptoms had more unfavorable prognosis than patients with painless hematuria. Size and configuration of the tumors also affected the prognosis. Histological diagnosis was transitional cell carcinoma in 291 patients, squamous cell carcinoma in 7 patients, adenocarcinoma in one patient and undifferentiated carcinoma in one patient. In patients with transitional cell carcinoma, the 5-year survival rates according to histological grades were 93.5% for G1, 77.8% for G2 and 31.6% for G3. The 5-year survival rate according to clinical stage was 94.4% for Ta, 79.7% for T1, 66.7% for Tis, 46.1% for T2, 38.5% for T3 and 26.6% for T4. Transurethral resection of bladder tumor (TUR-b.t.) was performed in 208 patients as an initial operation and the 5-year survival rate in these patients was 78.6%. The 5-year survival rates for total cystectomy (52 patients), partial cystectomy (6 patients) and simple tumor resection (4 patients) were 51.9%, 25.0% and 37.5%, respectively. These findings suggest that superficial tumors (Ta, T1) can be controlled with TUR-b.t. but infiltrating tumors (T2, T3, T4) should be treated more vigorously with multidisciplinary approaches.(ABSTRACT TRUNCATED AT 250 WORDS)