表在型膀胱癌に対するTUR-Bt後の再発防止に関する検討

Abstract

1)表在性膀胱癌63症例に対してTUR-Bt後3日間のブレオマイシン持続膀胱内灌流, BCG膀胱内注入, UFT経口投与による再発予防の有用性を封筒法によるrandomized studyによって検討した。2)BCG投与群34例, BCG非投与群29例の3年非再発率は, おのおの80.1%, 72.1%と両群ともに高い再発防止効果がえられた。3)3年非再発率は, BCG投与群の方がBCG非投与群よりも勝っていたが, その差は推計学的に有意ではなかった。4)BCG投与による副作用は76.5%に認められたが, いずれも軽度から中等度のもので重篤のものではなかった。5)TUR-Bt後3日間のブレオマイシン持続膀胱内灌流, BCG膀胱内注入およびUFT経口投与による集学的再発予防法は, 単剤による再発予防法に比しより効果が期待できる方法と思われた

We evaluated 63 patients with superficial bladder cancer (pTa, pTl) who were treated with instillation of bleomycin +/- bacillus Calmette-Guerin (BCG) and administration of uraciltfutraful (UFT) for prophylaxis of tumor recurrence after transurethral resection (TUR). The patients were randomly assigned to groups A and B after transurethral resection by the closed envelope method. Group A (34 cases) was designed as continuous diluted intravesical instillation of bleomycin (120 mg/2, 000 ml saline solution/day repeated for 3 days), instillation BCG (40 mg/40 ml saline solution/weekly 6 times) and UFT (400 mg orally/day for 2 years maximum). Group B (29 cases) was designed as the aforementioned minus BCG instillation. Cumulative non-recurrence rates in group A and group B were 80.1% and 72.1% at the time of three years, which revealed no significant difference between the two groups (p = 0.265, generalized Wilcoxon test). The high recurrent incidence of superficial bladder cancer is primarily due to the multifocal nature of the cancer or implantation of tumor cells at the time of the subsequent transurethral resection. The procedure was performed safely with no severe side effects. Our method might be useful to reduce the recurrences of superficial bladder cancer after transurethral resection of bladder (TUR).