筋層非浸潤性膀胱癌における経尿道的膀胱腫瘍切除術（TURBT）後塩酸ピラルビシン（THP）3日間連続膀胱内注入療法の膀胱内再発に関する検討

Abstract

We estimated the results of 3-day consecutive intravesical instillation of pirarubicine hydrochloride (THP) following transurethral resection of bladder tumor (TURBT) for non-muscle-invasive bladder cancer retrospectively. Through March 1995 to April 2009, a total of 184 patients were instilled 3-day consecutive intravesical instillation of pirarubicine hydrochloride (THP) (30 mg/40 ml in disinfected distilled water) started within a few hours after TURBT. 184 patients were diagnosed as untreated fresh non-muscle-invasive urothelial bladder cancer with no concomitant carcinoma in situ (CIS), no concurrent upper urinary tract urothelial cancer and no past history of upper urinary tract urothelial cancer. Number of tumors, tumor size, tumor grade and clinical tumor stage were analyzed in relation to tumor recurrence by univariate and multivariate analyses. Median follow-up were 55.1 months. Using EAU guideline on non-muscle invasive urothelial carcinoma of the bladder, 168 patients were classified at intermediate risk of tumor recurrence, 14 patients were at low risk of tumor recurrence and 2 patients were at high risk of tumor recurrence. The shape of non-recurrence rate curve showed two phase decrease pattern, namely, early hasty decrease within 1.5 or two years and late gentle decrease thereafter. The 1, 2, 3, 5-year non-recurrence rate were 82.7%, 75.3%, 72.3% and 67.4% respectively. The 3-year non-recurrence rate of low score group (recurrence score 1-3) at intermediate risk of tumor recurrence was 85.3%. Univariate analysis revealed that number of tumors, tumor grade and clinical tumor stage were related to tumor recurrence (p<0.05). By multivariate analysis, number of tumors and clinical tumor stage were related to tumor recurrence (p<0.05). In patients of low score group at intermediate risk of tumor recurrence without grade 3 urothelial carcinoma and concomitant bladder CIS, 3-day consecutive intravesical instillation of pirarubicine hyorochloride (THP) following TURBT for non-muscle-invasive bladder cancer would be a significant adjuvant therapy. But in patients of high score group at intermediate risk of tumor recurrence, it seemed better to do additional maintenance intravesical chemotherapy or intravesical BCG therapy.