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2編: 膀胱粘膜多部位生検の所見と臨床経過

Abstract

膀胱粘膜多部位生検を行った111例の膀胱癌症例について, 治療後の臨床経過の検討を行った.治療法はTUR129回, 膀胱全摘19回, その他3回で, TUR75例について累積非再発率を計算した.全例の累積非再発率は術後12ヵ月で約65%と急速に低下した.累積非再発率は腫瘍の単発症例が多発症例よりも有意に高く, 粘膜生検で異常を認めなかった群に有意に高かった.また生検粘膜537検体のうち, 生検で異常を認めなかった生検部位と同一領域の非再発率が有意に高かった.粘膜生検法で上皮内癌を15例に証明し, その最終的治療はTUR5例, 膀胱全摘8例, 対症療法的TURと内腸骨動脈塞栓術2例で, この2例を除き13例が18～42ヵ月生存中である.上皮内癌の微小浸潤を証明したのは13例で, その最終的治療はTUR 3例, 膀胱全摘9例, 抗癌化学療法1例であり, このうちA型でTURと抗癌剤膀胱腔内注入を行った1例とC型の3例の計4例が癌死に至った

The predictive value of grade, number of tumor and histology of mucosal biopsy for tumor recurrence, the course of carcinoma in situ and microinvasion of carcinoma in situ were examined. The Kaplan-Meier's method was used for the estimation of the recurrence-free rate in the patients who had undergone transurethral resection (TUR) and the logrank test for testing the significance of difference in recurrence-free rate. The 5-year recurrence-free rate was 32.2%. The recurrence-free rate was 51.0% after 40 months postoperatively in patients with a single tumor, 12.8% after 42 months postoperatively in those with multiple tumors. The patients with a single tumor had a significantly higher recurrence-free rate than those with multiple tumors (P less than 0.001). The recurrence-free rate was analyzed according to the grade of main tumor, but significantly difference was not present. The recurrence-free rate was 44.4% after 42 months postoperatively in patients with normal histology of mucosal biopsy and 9.5% after 34 months postoperatively in those with abnormal histology. The patients showing normal histology in mucosal biopsy had a significantly higher recurrence-free rate than those with abnormal findings (P less than 0.001). the recurrence-free rate at the same area of biopsy site was analyzed according to the histologies of 537 mucosal biopsies. The recurrence-free rate was 76.7% after 42 months post operatively in areas with a normal biopsy, 44.3% after 35 months postoperatively in those with abnormal histology and the difference was statistically significant (P less than 0.001). Of the 15 patients found to have carcinoma in situ, 4 were primary carcinoma in situ, 6 were associated with superficial papillary tumors and 5 were associated with invasive tumors. Thirteen of the 15 patients were alive and free of disease 18 to 42 months later. Two patients associated with invasive tumor died 5 and 18 months after transcatheter embolization of internal iliac arteries. Of the 13 patients who were found to have microinvasion of carcinoma in situ, 4 were not associated with visible tumor, 6 were associated with superficial papillary tumor and 3 were associated with invasive tumors. Nine of the 13 patients are alive and free of disease 7 to 53 months later. A patient without any visible tumor who was treated with TUR and intravesical chemotherapy died and three patients with invasive tumor died irrespective of the mode of treatment.(ABSTRACT TRUNCATED AT 400 WORDS)