膀胱癌症例に対する膀胱粘膜多部位生検に関する研究 第3編: 膀胱粘膜多部位生検組織におけるABH抗原の検討

Abstract

1980年4月より1983年6月までの期間に加療した膀胱癌89症例に粘膜生検法を行い, 主腫瘍の生検組織126検体, 生検粘膜組織723検体を対象として組織内血液型抗原を検索した.血液型抗原陽性率は上皮内癌の微小浸潤17%, 上皮内癌29%, 移行上皮癌47%, 上皮異形成35%, 上皮過形成71%, などであった.主腫瘍の血液型抗原陽性率は組織学的異型度の上昇とともに低下し, 組織学的深達度との間には相関が見られなかった.血液型抗原の有無と生検粘膜の組織学的所見との関連では, 陰性例において組織学的異常が見られる頻度が高かった.TUR症例において5年累積非再発率は, 主腫瘍の血液型抗原陽性例に57.3%と高かった.累積非再発率は血液型抗原陽性の主検領域では手術後63ヵ月の時点で82.8%と有意に高かった.層別の検討では, 生検粘膜の組織学的所見が上皮異形成, 正常粘膜の領域において, 累積非再発率が有意差をもって高かった

Eighty-nine patients with bladder cancer underwent multiple mucosal biopsies of the bladder mucosa 129 times between April 1980 and June 1983. In total there were 126 tumor specimens and 723 mucosal biopsies. Blood group antigens (BGA) were detected by means of the specific red cell adherence (SRCA) test in blood group A, AB, and B patients and direct immunoperoxidase method in blood group O patients. Histological abnormalities in this paper indicate transitional cell carcinoma, microinvasion of carcinoma in situ, carcinoma in situ, dysplasia and hyperplasia. The Kaplan-Meier's method was used for the estimation of recurrence-free rate and logrank test for testing the significance of difference in recurrence-free rate. The BGA-positive rate in mucosal biopsies was 17% for microinvasion of carcinoma in situ, 29% for carcinoma in situ, 47% for transitional cell carcinoma, 35% for dysplasia, 71% for hyperplasia, 100% for squamous metaplasia, 87% for proliferative cystitis and 77% for normal epithelium. Of histological findings, microinvasion of carcinoma in situ, carcinoma in situ, transitional cell carcinoma and dysplasia showed a significantly lower BGA-positive rate than proliferative cystitis and normal epithelium (P less than 0.001). The BGA-positive rate of main tumor was 61% in G1 tumors, 23% in G2 tumors and 21% in G3 tumors. The BGA-positive rate was shown to be decreasing with the increase in the histological grade of main tumor, and this reciprocal relationship was statistically significant (P less than 0.005). No statistical correlation between BGA in tumors and histological stage was found. The frequency of histological abnormalities in mucosal biopsy was 5.2% in patients with BGA-positive tumors, 21.2% in those with BGA-negative tumors, the difference being statistically significant (P less than 0.001). The 5-year recurrence-free rate after transurethral resection (TUR) was 57.3% in patients with BGA-positive tumors, 18.2% in those with BGA-negative tumors, the difference between the 2 groups being significant (P less than 0.001).