腎盂尿管腫瘍における膀胱粘膜多部位生検の意義

Abstract

We reviewed significance of multiple biopsies obtained from bladder mucosa in 59 patients of renal pelvic and ureteral carcinoma treated at Osaka Police Hospital between 1990 and 2003. The patients consisted of 41 males and 18 females. The median age was 68 years, ranging from 42 to 91 years. Multiple biopsies were carried out in principle to examine the following 5 cystoscopically normal-appearing bladder mucosal sites: (1) trigone, (2) posterior wall, (3) left lateral wall, (4) right lateral wall and (5) dome. Positive case of multiple biopsies was defined as patients having abnormalities in at least one biopsy specimen such as bladder tumor (BT) or dysplasia. Median follow-up period was 54 months. Of the 59 patients, 6 had positive multiple biopsies. Among them 3 had carcinoma n situ (CIS), and others had dysplasia. 4 patients with positive multiple biopsies had past or concurrent history of BT and received adjuvant intravesical instillation therapy. Positive rate of multiple biopsies significantly differed between patients with and without past and/or concurrent BT (4/15: 27% vs 2/44: 5% p = 0.03), indicating that multiple biopsies were useful to detect abnormal lesion accompanied with past and/or concurrent BT. 3-year bladder recurrence free rate was 61%. Postoperative bladder recurrence rate did not significantly differ between positive (1/6 17%) and negative (20/53: 38%) cases of multiple biopsies. Univariate analysis indicated stage (p = 0.03) and venous involvement (p = 0.02) to be significant prognostic factors for bladder recurrence free rate, but not multiple biopsies, although multivariate analysis with Cox's proportional hazard model revealed no independent prognosticators. Low recurrence rate of patients with positive multiple biopsies was possibly due to adjuvant intravesical instillation therapy to prevent bladder recurrence.