膀胱癌に対する根治的膀胱摘除後の局所再発症例の予後

Abstract

The clinical outcome is poor for patients who have local recurrence after radical cystectomy for bladder cancer. We investigatedclinical outcomes of patients with isolatedlocal recurrence andwith both local recurrence and distant metastasis. From 1990 to 2006, 299 patients who had bladder cancer without distant metastasis underwent radical cystectomy in our hospital. We included 200 patients who had a negative surgical margin at radical cystectomy andurothelial carcinoma, andwho hadnot hadupper urinary tract cancer or other active cancer. Fifteen (7.5%) hadisolatedlocal recurrence (isolatedgroup) and18 (9.0%) hadlocal recurrence andd istant metastasis simultaneously (simultaneous group). The median overall survival time andthat for survival after recurrence were 24 and13 months, respectively, in the isolatedgroup, and18 and5 months, respectively, in the simultaneous group. Although we didnot finda significant difference in overall survival (p=0.314), there was one for survival after recurrence (p=0.001) between the two groups. In the isolatedgroup, 13 diedof cancer, 1 of another cause and1 was alive without cancer. All patients in the simultaneous group diedof cancer. Three patients in the isolatedgroup underwent surgery for residual tumors after systemic chemotherapy, and2 of the 3 survivedfor more than 2 years after recurrence. Some patients with isolatedlocal recurrence benefitedfrom multimodal therapies. In these patients, surgery for the residual tumor after systemic chemotherapy was likely to be effective if a negative margin was achievedin surgical specimens.