膀胱癌が先行したのちに発生した上部尿路上皮腫瘍の検討

Abstract

1969年以降16年間に519例の原発性膀胱癌患者を治療し, その後に発生した上部尿路腫瘍12症例について検討した.1)全発生頻度は2.3%であった.そのうち, 自然発生膀胱癌患者群における発生頻度1.1%であるのに対し, 職業性膀胱癌患者群では13.2%にも及んだ.2)原発性膀胱癌に対してTURまたはTUCなど経尿道的治療を行なった患者群に多発し, 膀胱全摘出術後に発生したものは1例のみであった.3)原発性膀胱癌治療後, 上部尿路腫瘍発生までの期間は平均70ヵ月であり, 年数の経過とともに発生率の増加する傾向がみられた.4)その発生様式としては, 尿中発癌物質によって不安定化した尿路上皮細胞に, 非特異的刺激が加わって促進されたものと考えられた

Five hundred and nineteen patients with primary bladder cancer were treated between January, 1969 and December, 1984, 12 of whom had developed upper urothelial tumors. These patients had received various transurethral treatment for the primary bladder lesions, except for one patient who had undergone total cystectomy and ileal conduit diversion. Overall incidence of patients with upper urinary tract tumors following bladder cancer was 2.3%. The incidence of patients with treated bladder tumors (13.2%) for dye workers was higher than that for the general population (1.1%). The interval between initial treatment of the bladder tumor and diagnosis of the upper tract tumor ranged from 7 to 170 months (mean 70 months). The incidence of upper tract tumors increased with the passage of time. We conclude that the occurrence of upper urinary tract tumors following primary bladder cancers is promoted by nonspecific chemical irritants against the urothelium already made unstable by certain urinary chemical carcinogens.