膀胱腫瘍の異所性再発例の検討

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過去17年間に経験した膀胱腫瘍144例について,異所性再発とadjuvant therapyの再発予防効果,再発に関与するリスクファクターの検討を行った.術後症例の36.8%に異所性再発を認め,再発例の再度再発する危険性は発回治療例より高く,初回例よりさらに厳重なfollow upが必要である.High grade, high stage, 3 cm以上の腫瘍に再発のリスクが高い.MMCやADM膀注は術後長期に若干の再発予防効果を認めたが,5FU内服は全体としては効果を認めず,個々の症例では有効であったものがあり,adjuvant therapyの効果は症例により異なり一律に否定できなかった.再発例の11.3%に悪性進展を認め,とくにgrade 3の症例は悪性進展のリスクが高いものとして厳重な経過観察が必要と思われたConservative therapy, preserving bladder function, is most commonly done for the treatment of bladder tumors. However, prevention of intravesical ectopic recurrence remains to be the major postoperative problem. Between April, 1969 and March, 1986. 144 patients were treated conservatively at our Hospital. Initial recurrence occurred in 36.8% of the conservatively treated cases. Second recurrence occurred in 73.2% twice the rate of initial recurrence. No differences were noted between the recurrence rate of single and multiple tumors. Overall recurrence rate according to histological grade was 0% for Grade 0, 36.4% for Grade 1, 36.8% for Grade 2, and 50.0% for Grade 3. The overall recurrence rate of the group without postoperative prophylactic adjuvant therapy was 37.0%. The overall recurrence rate according to postoperative prophylactic adjuvant therapy was 28.6% for intravesical Mitomycin C (MMC) instillation, 30.0% for intravesical Adriamycin (ADM) instillation, 36.8% for external irradiation, 42.9% for fluorouracil (5FU) administration and 100% for 5FU + intravesical instillation. As a whole 5FU is not effective. However, in 1 patient who had had seven previous recurrences, no recurrence has occurred for over seven years after 5FU administration. Effect of adjuvant therapy differs in each case and cannot be regarded in the same light. High grade, high stage, and large (greater than 3 cm) tumors show a high recurrence rate. Progression (grade up, stage up) occurred in 11.3% of the recurrence cases.

膀胱腫瘍の異所性再発例の検討

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