Numasawa K, Kakizaki H, Hirano J, Kubota Y, Suzuki K, Hirano K, Suzuki H
Department of Urology, Yamagata University School of Medicine.
Hinyokika Kiyo. 1989 Aug;35(8):1291-8.
During the 10-year-and-9-month period from July 1977 to March 1988, 34 cases of renal pelvic and ureteral cancer were surgically treated with total nephroureterectomy combined with partial cystectomy. In cases where the histopathological examination of the surgically excised specimen disclosed a high stage, high grade cancer with vascular tumor invasion, postoperative adjuvant chemotherapy was carried out using cisplatin, cytosine arabinoside and tegafur. Of the 34 cases, 22 are still alive, 7 (20.6%) died of cancer and 5 died of other causes. Histopathologically, all of the 7 patients who died of cancer were found to have grade 3 and stage pT2 or pT3 cancers with intravascular tumor invasion. Cisplatin was used in 13 of the 18 high grade, high stage cases with intravascular tumor invasion. The mortality due to cancer in these 13 cases was 30.8%, while 3 and 5-year survival rates were 69.2% and 51.9%, respectively. In the remaining 5 cases in which cisplatin was not used for postoperative chemotherapy, the mortality due to cancer was 60.0% and the 3 and 5-year survival rates were 53.3% and 26.7%, respectively. Thus, the patients who received postoperative chemotherapy tended to show a better survival rate than those who did not, although the difference in the survival curves between the two groups was not statistically significant. The results from the present study suggest the usefulness of postoperative adjuvant chemotherapy in high stage, high grade renal pelvic and ureteral cancer with intravascular tumor invasion.
在1977年7月至1988年3月的10年9个月期间，对34例肾盂及输尿管癌患者实施了肾输尿管全切术联合部分膀胱切除术。若手术切除标本的组织病理学检查显示为高分期、高分级且伴有血管侵犯的癌症，则术后使用顺铂、阿糖胞苷和替加氟进行辅助化疗。34例患者中，22例仍存活，7例（20.6%）死于癌症，5例死于其他原因。组织病理学检查发现，所有7例死于癌症的患者均为3级且分期为pT2或pT3的癌症，并伴有血管侵犯。18例伴有血管侵犯的高分级、高分期病例中，13例使用了顺铂。这13例患者的癌症死亡率为30.8%，3年和5年生存率分别为69.2%和51.9%。其余5例术后未使用顺铂化疗的患者，癌症死亡率为60.0%，3年和5年生存率分别为53.3%和26.7%。因此，接受术后化疗的患者生存率往往高于未接受化疗的患者，尽管两组生存曲线的差异无统计学意义。本研究结果提示术后辅助化疗对伴有血管侵犯的高分期、高分级肾盂及输尿管癌有用。
