尿路上皮癌の再発・進展というテーマに対し第1章では尿路上皮癌の診断、治療に関 する背景と問題点を解説し、さらに尿路上皮癌の重要な特徴でもある“時間的・空間的 多発”についてもふれた。第2章では偶然経験した稀な症例においてFISHを用いるこ とで尿路上皮癌のimplantationによる空間的多発を証明できた。さらに第3,4章では 頻度は低いが臨床的に極めて重要な2つの疾患について臨床的研究をすすめ、いまだ確 立されていない治療法の可能性について検討した。
第3章では、再発ハザード曲線の比較から腎盂・尿管癌術後の膀胱内再発は筋層非浸 潤性膀胱癌low risk 群の臨床経過と類似することが明らかになり、腎盂・尿管癌術後 の膀胱内再発に対する抗癌剤即時膀胱内単回注入療法の有用性が示唆された。最近、東 北大学を中心としたグループによる第Ⅱ相試験が施行されており、77名の腎盂・尿管 癌患者を対象とした前向き比較試験において腎尿管全摘後、抗癌剤即時膀胱内単回注入 療法施行群が未施行群に比べその後の膀胱内再発を有意に減少させたと報告[84]され ている。間接的ではあるが本研究結果は彼らの研究結果を支持する内容であると考えて いる。
第4章ではT1 high grade筋層非浸潤性膀胱癌に対するsecond TUR後の膀胱内再発 予測因子が明らかになり、second TUR後のBGC膀胱内注入療法の有用性も示唆され た。後者については現在、日本臨床腫瘍研究グループ(Japan Clinical Oncology
Group :JCOG)においてJCOG1019 studyとしてランダム化第Ⅲ相試験が進行中であ り今後の結果が待たれるところである。
腎盂・尿管癌やT1 high grade筋層非浸潤性膀胱癌は臨床的に頻度が低いため、大規 模データがなく、治療後再発に対する確立した治療戦略がないのが現状である。しかし 小規模データであってもそれらを詳細に解析し、既存の大規模データと比較することで 新たな診断法、治療法の開発に結び付くものと考える。
謝辞
本稿を終えるにあたりご指導、ご校閲を賜りました筑波大学医学医療系腎泌尿器外科 学教授 西山博之先生、筑波大学医学医療系腎泌尿器外科学准教授 宮崎淳先生に深甚 なる謝意を表します。
腎盂・尿管癌術後の膀胱内再発に関する研究にて研究の遂行ならびに論文指導を賜り ました東京大学先端科学技術センター特任教授 赤座英之先生、岡山大学新医療研究開 発センター教授 樋之津史郎先生に深謝いたします。
T1 high grade筋層非浸潤性膀胱癌に対するsecond TUR後の再発・進展に関する研 究にて研究の遂行ならびに論文指導を賜りました筑波大学医学医療系腎泌尿器外科学 教授 西山博之先生、筑波大学医学医療系腎泌尿器外科学准教授 宮崎淳先生に深謝い たします。
本研究成果のうち第3章“腎盂・尿管癌術後の膀胱内再発に関する研究”は日本泌 尿器科学会編、腎盂・尿管癌診療ガイドライン2014年版で引用されました。
最後に本研究に際し、ご協力をいただいた筑波大学附属病院腎泌尿器外科グループの 皆様に深く感謝いたします。
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