膀胱癌による膀胱全摘の治療成績

Abstract

1973年より1983年の間に原発性膀胱癌95例に対し膀胱全摘除を行なった.「泌尿器科, 病理膀胱癌取扱い規約」に従い, その病理組織と予後についての検討を加えた.膀胱癌の組織型別には, 移行上皮癌87例, 扁平上皮癌5例, 腺癌2例および未分化癌1例であった.全体の5年実測生存率は36.0%であった.増殖様式に関しては, 乳頭状非浸潤型100%, 乳頭状浸潤型25.8%, 非乳頭状浸潤型34.8%であった.5年生存率と進展度との関係では, pTa 81.1%, pT1 64.7%, pT2 40.1%, pT3a 30.5%, pT3b 22.6%, pT4 6.7%であり, 移行上皮癌87例のうち5年生存率と悪性度との関係では, grade 1 100%, grade 2 43.0%, grade 3 32.1%であった.予後指標としては, 壁内リンパ球浸潤, 血管浸潤および壁内浸潤の病理組織学的様式が重要であった

Total cystectomy was performed on 95 patients with primary urinary bladder cancer between 1973 and 1983. Histopathological and prognostic studies were reviewed according to the general rules for clinical and pathological studies on bladder cancer. The cancer histological type were transitional cell carcinoma in 87 cases, squamous cell carcinoma in 5 cases, adenocarcinoma in 2 cases, and undifferentiated carcinoma in 1 case. The overall 5-year actuarial survival rate was 36.0%. As for the growth pattern of the bladder cancer, the 5-year survival rates for the patients with papillary non-invasive type (PNT), papillary invasive type (PIT), and non-papillary invasive type (NIT) were 100%, 25.8% and 34.8% respectively. As for the stage, the 5-year survival rates for the patients with pTa, pT1, pT2, pT3a, pT3b, and pT4 were 81.8%, 64.7%, 40.1%, 30.5%, 22.6% and 6.7% respectively. Of 87 patients with transitional cell carcinoma, the 5-year survival rates for the patients with grade 1, grade 2 and grade 3 were 100%, 43.0% and 32.1% respectively. Intramural lymphatic invasion and vascular invasion and intramural histopathological mode of spread were significant indicators of prognosis.