臨床泌尿器科73巻11号

2019年10月発行

特集 希少癌に備える―いざという時のための基礎知識

Variantタイプ膀胱癌

著者： 南雲義之¹ 小島崇宏¹ 西山博之¹

所属機関： ¹筑波大学医学医療系腎泌尿器外科

ページ範囲：P.842 - P.845

▶ポイント

・膀胱の尿路上皮癌にはさまざまなvariantが存在し，膀胱癌全体の20〜25％程度とされている．

・Variantのタイプによって予後へ影響を与える可能性が異なるため，症例ごとに治療方針を検討する必要がある．

・尿路上皮癌におけるvariantの頻度はこれまで考えられていたよりも高く，標準治療の確立に向けて，分子解析も含めた多施設共同研究が望まれる．

参考文献

1） Dahm P and Gschwend JE : Malignant non-urothelial neop ; asms of the urinary bladder : a review. Eur Urol 44 : 672, 2003

2） Shah RB, Montgomery JS, Montie JE, et al : Variant （divergent） histologic differentiation in urothelial carcinoma is under-recognized in community practice : impact of mandatory central pathology review at a large referral hospital. Urol Oncol 31 : 1650-1655, 2013

3） Moschini M, D'Andrea D, Korn S, et al : Characteristics and clinical significance of histological variants of bladder cancer. Nat Rev Urol 14 : 651-668, 2017

4） Wasco MJ, Daignault S, Zhang Y, et al : Urothelial carcinoma with divergent histologic differentiation （mixed histologic features） predicts the presence of locally advanced bladder cancer when detected at transurethral resection. Urology 70 : 69-74, 2007

5） Cai T, Tiscione D, Verze P, et al : Concordance and clinical significance of uncommon variants of bladder urothelial carcinoma in transurethral resection and radical cystectomy specimens. Urology 84 : 1141-1146, 2014

6） Ghoneim IA, Miocinovic R, Stephenson AJ, et al : Neoadjuvant systemic therapy or early cystectomy? Single-center analysis of outcomes after therapy for patients with clinically localized micropapillary urothelial carcinoma of the bladder. Urology 77 : 867-870, 2011

7） Yorozuya W, Nishiyama N, Shindo T, et al : Bacillus Calmette-Guérin may have clinical benefit for glandular or squamous differentiation in non-muscle invasive bladder cancer patients : retrospective multicenter study. Jpn J Clin Oncol 48 : 661-666, 2018

8） Scosyrev E, Ely BW, Messing EM, et al : Do mixed histological features affect survival benefit from neoadjuvant platinum-based combination chemotherapy in patients with locally advanced bladder cancer? A secondary analysis of Southwest Oncology Group-Directed Intergroup Study （S8710）. BJU Int 108 : 693-699, 2011

9） Bellmunt J, de Wit R, Vaughn DJ, et al : Pembrolizumab as Second-Line Therapy for Advanced Urothelial Carcinoma. N Engl J Med 376 : 1015-1026, 2017

10） Wright JL, Black PC, Brown GA, et al : Differences in survival among patients with sarcomatoid carcinoma, carcinosarcoma and urothelial carcinoma of bladder. J Urol 178 : 2302-2306, 2007

11） Scosyrev E, Yao J and Messing E : Urothelial carcinoma versus squamous cell carcinoma of bladder : is survival different with stage adjustment? Urology 73 : 822-827, 2009

12） Wright JL, Porter MP, Li CI, et al : Differences in survival among patients with urachal and nonurachal adenocarcinomas of the bladder. Cancer 107 : 721-728, 2006

13） Moschini M, Dell'Oglio P, Luciano' R, et al : Incidence and effect of variant histology on oncological outcomes in patients with bladder cancer treated with radical cystectomy. Urol Oncol 35 : 335-341, 2017

14） Cheng L, Pan CX, Yang XJ, et al : Small cell carcinoma of the urinary bladder : a clinicopathologic analysis of 64 patients. Cancer 101 : 957-962, 2004