琉球大学における膀胱腫瘍の治療法とその臨床効果について - 86症例の治療経験 -

Abstract

1) TUR-BT症例において, 再発率は49例中17例, うち9例が膀胱全摘出術となった.他の40例はTUR-BTのみでその後も膀胱全摘出術せず, 免疫化学療法を継続することができた.2)これら40例の実測生存率は80%であった.3)膀胱全摘出術の症例数は37例で, pT2以下の5年実測生存率は72%, pT3以上では10%, 全体では54%であった.4)膀胱腫瘍の治療上の問題点は, TUR-BT症例においては術後再発率が高いこと, また膀胱全摘出術症例ではpT3以上の生存率が低いことである

Prognosis on evaluable 86 patients with primary bladder tumor seen during the 10 years up to 1985 was evaluated in relation to treatment mode and tumor stage. The majority of patients underwent multimodal therapies including surgery, chemotherapy and immunotherapy with picibanil (OK432). Transurethral resection of the tumor was performed as an initial surgical treatment in 49 patients, 9 of whom ultimately underwent total cystectomy. After leaving hospital, these patients were kept on immunotherapy with OK432 and topical chemotherapy with bladder instillation of mitomycin C or adriamycin (ADM) with or without systemic administration of Tegefur as long as possible. The overall actual 5-year survival rate for the patients treated by initial transurethral resection was 80%. Recurrence rate for these 49 patients was 35%. Total cystectomy with urinary diversion was performed in 37 patients who had been placed postoperatively on systemic administration of Tegafur and immunotherapy with OK 432 as long as possible. The overall actual 5-year survival rate for the patients treated with total cystectomy was 54%. The patients with pT2 and lower stage tumor had an actual 5 year survival rate of 72%, while the patients with pT3 and higher stage tumors had a survival of 10%. The high recurrence rate in the patients with superficial tumor and the low actual survival rate of the patients with pT3 and higher stage remain a problem in the treatment of bladder tumor. In recent trials, bacillus Calmette-Guerin instillation therapy has been initiated to lower the recurrence rate in superficial tumor and we have had a satisfactory 4-year result.(ABSTRACT TRUNCATED AT 250 WORDS)