浸潤性膀胱癌の治療成績

Abstract

1) 20年間(1965～1984)(膀胱癌患者数843例)に膀胱全摘出術を行なったのは156例18.5%であった.2) 1965～1974年は35例, 1975～1984年は115例で後半は3倍強の増加をしめした.3)男性の増加, 平均年齢の上昇がみられ, 筋層浸潤例の増加がみられた.4)リンパ節郭清症例の5年生存率66%に対し, 郭清なしまたは生検のみの場合の5年生存率は35%であった.5)リンパ節転移がない場合の5年生存率は73%, リンパ節転移がある場合は11%であった.6) T2以上の症例についての集学的治療施行群の5年生存率は55%, それ以前の症例は30%で, 術前照射を含む集学的治療法群は有意に高い生存率を示した.7)放射線による組織学的治療効果度(大星-下里による)で2b以上をresponder, 2a以下をnon-responderとした.responder 28例(54%)の5年生存率は87%, non-responder 24例(46)の場合は48%で, responderの生存率は有意に高い.8)深達度別5年生生存率はpT1以下95%, pT2以上は49%であった

Of the 843 patients with bladder cancer treated at Kyoto University between 1965 and 1984, 156 patients (18.6%) received total cystectomy. Between 1980 and 1984, 60 patients underwent multidisciplinary treatment with 4, 000 or 2, 400 rad adjuvant preoperative radiation therapy to the whole pelvis followed by radical cystectomy with or without postoperative adjuvant chemotherapy. The 5-year survival rate for the 65 patients with pelvic lymphadenectomy was 66% and that for the 40 patients without lymphadenectomy or only biopsy was 35%. The 5-year survival rate after radical cystectomy for 20 bladder cancer patients with regional lymph node metastasis was 11% and 73% for 59 patients without lymph node metastasis (p less than 0.001). The survival rate of multidisciplinary treatment protocol for muscle invasive bladder cancer was 55% a significantly (p less than 0.05) improved survival compared to the historical control. For analysis, the patients were divided into 2 categories according to histological criteria for evaluation of therapeutic effects for preoperative radiation by Ohoshi and Shimosato. The two groups were non-responder: grade I and IIa changes and responder: grade IIb, III and IV. Survival for responders and non-responders revealed significant differences (p less than 0.05), 87% for 28 responders and 48% for 24 non-responders.