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tṁE”AŠÇŠŕ@`f—ĂƒKƒCƒhƒ‰ƒCƒ“

ƒKƒCƒhƒ‰ƒCƒ“•ś’†‚Ě•śŒŁ”ԍ†‚Š‚çCŠY“–‚ˇ‚é\‘˘‰ť´˜^‚ĚŽQĆ‚Ş‚Ĺ‚Ť‚Ü‚ˇ

–ÚŽŸ:


Ⅰ ‰uŠw

‘ ˜_

Ⅰ ‚Í‚ś‚ß‚É

tṁE”AŠÇŠŕ‚́Ct᱔AŠÇ‚Ě”A˜Hă”çiˆÚsă”çj”S–Œ‚ć‚č”­ś‚ˇ‚éˆŤŤŽîᇂł ‚čC•a—‘gDŠw“I‚ɂ́C‚ť‚Ě–ń90“ˆČă‚Í”A˜Hă”çŠŕ‚Ĺ‚ ‚é‚ŞC‹H‚ɝG•˝ă”çŠŕC‘BŠŕCŹ×–EŠŕC–˘•Ş‰ťŠŕ“™‚Ş‚ ‚é1jBtṁE”AŠÇŠŕ‚́C“Ż‚ś”A˜Hă”ç‚Š‚ç”­ś‚ˇ‚éäNă÷Šŕ‚ɔ䂾‹H‚Ĺ‚ ‚čC‘S”A˜Hă”çŽîᇂ̖ń5%‚đč‚ß‚é‚Ć‚ł‚ę‚Ä‚˘‚éB”AŠÇŽîᇂ̔­ś•p“x‚͐tᱎîᇂ̖ń‚P/ ‚S‚Ć‚ł‚ę‚Ä‚˘‚é2jBtṁE”AŠÇŠŕ‚́C50~70 Î‘ă‚É‘˝‚­”F‚ß‚ç‚ęC’jŤ‚Ě‚Ů‚¤‚ޏ—Ť‚ć‚č•p“x‚ލ‚‚­C‚Q”{ˆČă‚Ć‚ł‚ę‚Ä‚˘‚é3j|6jBŒúś˜J“­Č‘ĺbŠŻ–[“Œvî•ń•”‚̐lŒű“Ž‘Ô“Œv‚É‚ć‚é‚ƁCt᱂̈ŤŤVś•¨‚É‚ć‚鎀–S”‚Í2002 ”N781 l‚ɑ΂ľC2006 ”N1,200 lC2010 ”N1,558 l‚Ć‘‰ÁŒXŒü‚đŽŚ‚ľ‚Ä‚˘‚éB”AŠÇ‚ĚˆŤŤVś•¨‚É‚ć‚鎀–S”‚ŕ2002 ”N852 l‚ɑ΂ľ‚āC2006 ”N1,105 lC2010 ”N1,593 l‚Ĺ‘‰ÁŒXŒü‚đŽŚ‚ľ‚Ä‚˘‚é7jB

Ⅱ •a ˆö

tṁE”AŠÇŠŕ”­Ç‚ĚŠëŒŻˆöŽq‚Ć‚ľ‚ẮC‹i‰Œ‚âˆă–ň•iC–ŤŠ´őÇC‰ťŠw”­Šŕ•¨Žż‚Ě”˜˜ICE‹ĆŤ”­Šŕ‚Ş‹“‚°‚ç‚ę‚éiCQ1 ŽQĆjB‹i‰Œ‚ÍĹ‚ŕd—v‚ȐtṁE”AŠÇŠŕ‚ĚŠëŒŻˆöŽq‚ŁC‹i‰ŒŽŇ‚â‰ß‹Ž‚É‹i‰Œ—đ‚đ—L‚ˇ‚銳ŽŇ‚Ĺ‚Í”ń‹i‰ŒŽŇ‚Ć”ä‚אtṁE”AŠÇŠŕ‚Ě”­ÇƒŠƒXƒN‚Ş‘‰Á‚ˇ‚é‚Ć‚˘‚í‚ę‚Ä‚˘‚é8jBˆă–ň•i‚Ć‚ľ‚Ă̓VƒNƒƒzƒXƒtƒ@ƒ~ƒh‚âƒtƒFƒiƒZƒ`ƒ“‚Ě’ˇŠú˜A—p‚â—”—p‚É‚ć‚Á‚ĐtṁE”AŠÇŠŕ‚Ě”­ÇƒŠƒXƒN‚Şă¸‚ˇ‚é‚Ć‚˘‚í‚ę‚Ä‚˘‚é9j10jB‚Ü‚˝Šż•űiChinese herbj‚ĚˆęŽí‚Ĺ‚ŕ—ź‘¤ŤC‘˝”­Ť‚̐tṁE”AŠÇŠŕ‚đ”­Ç‚ľ‚₡‚˘‚ą‚Ć‚Ş’m‚ç‚ę‚Ä‚˘‚é11jB”A˜HŒ‹Î‚â”A˜H•ÂÇ‚É”ş‚¤–Ť×‹ŰŤŠ´ő‚͐tṁE”AŠÇŠŕ”­ś‚ĚƒŠƒXƒNˆöŽq‚ƍl‚Ś‚ç‚ę‚Ä‚˘‚éB“Á‚É‘gDŠw“I‚ɝG•˝ă”çŠŕ‚Ĺ‚ ‚éę‡‚́C–ŤŠ´őÇ‚ŞŠÖ—^‚ľ‚Ä‚˘‚éę‡‚Ş‘˝‚˘BE‹ĆŤ”­Šŕ‚Ć‚ľ‚ẮCÎ–űC–Ř’YCƒAƒXƒtƒ@ƒ‹ƒgCƒ^[ƒ‹‚Č‚Ç‚ĚŽY‹Ć]Ž–ŽŇ‚Í4~5 ”{‚̐tṁE”AŠÇŠŕ‚Ě”­ÇƒŠƒXƒN‚đ—L‚ˇ‚éB’nˆćŤ‚Ć‚ľ‚ẮCƒoƒ‹ƒJƒ“tÇiBalkan nephropathyj‚Ş’m‚ç‚ę‚Ä‚˘‚é12j13jBƒoƒ‹ƒJƒ“”‘‚É‚Ý‚ç‚ę‚閝ŤŠÔŽżŤt‰Š‚ĚŠłŽŇ‚ł́CtṁE”AŠÇŠŕ‚Ě”­ÇƒŠƒXƒN‚Í100~200 ”{‚Ć•ń‚ł‚ę‚Ä‚˘‚éBƒoƒ‹ƒJƒ“tÇ‚ÉŠÖ˜A‚ľ‚˝tṁE”AŠÇŠŕ‚Ílow gradeC‘˝”­ŤC—ź‘¤Ť‚É‹N‚ą‚č‚₡‚˘“Á’Ľ‚đ—L‚ľ‚Ä‚˘‚éB

tṁE”AŠÇŠŕ‚́CäNă÷‚â”A“š‚đŠÜ‚ß‚˝”A˜H“ŕo‘S‘Ě‚É‹óŠÔ“ICŽžŠÔ“I‚É‘˝”­‚ˇ‚é—Տ°“I“Á’Ľ‚đ—L‚ˇ‚éiCQ2 ŽQĆjB‚ˇ‚Č‚í‚żCt᱔AŠÇ“ŕo‚ÉŽîᇂޑ˝”­‚ľ‚Ä‘śÝ‚ˇ‚éę‡‚âCtṁE”AŠÇŠŕ‚̐f’fŽž‚É“ŻŽž‚ÉäNă÷Šŕ‚Ş‚Ý‚Â‚Š‚éę‡‚͏­‚Č‚­‚Č‚˘B‚Ü‚˝tṁE”AŠÇŠŕ‚̏pŒă‚ÉäNă÷Šŕ‚Ş”­śiÄ”­j‚ˇ‚é•p“x‚Í”äŠr“I‚‚˘14jB‚ł‚ç‚É”ńí‚É‹H‚Ĺ‚Í‚ ‚é‚ŞC—ź‘¤‚Ěă•””A˜H‚ɐtṁE”AŠÇŠŕ‚Ş“ŻŽžŤCˆŮŽžŤ‚É”­ś‚ˇ‚éę‡‚ŕ‚ ‚éBtṁE”AŠÇŠŕ‚âäNă÷Šŕ‚đ”F‚ß‚˝Žž‚ɂ́C”A˜H‘S‘Ě‚đƒXƒNƒŠ[ƒjƒ“ƒO‚ˇ‚é•K—v‚Ş‚ ‚éB

ŽQl•śŒŁ

1j “ú–{”ĺ”AŠí‰ČŠw‰ďC“ú–{•a—Šw‰ďC“ú–{ˆăŠw•úŽËüŠw‰ďi•ŇjFtṁE”AŠÇEäNă÷ŠŕŽćˆľ‚˘‹K–ńi‘ć‚P”ŁjD‹ŕŒ´o”ŁC“Œ‹žC2011D

2j Huben RP, Mounzer AM, Murphy GP. Tumor grade and stage as prognostic variables in upper tract urothelial tumors. Cancer. 1988; 62: 2016-20.

3j Anderström C, Johansson SL, Pettersson S, Wahlqvist L. Carcinoma of the ureter: a clinicopathologic study of 49 cases. J Urol. 1989; 142: 280-3.

4j Greenlee RT, Murray T, Bolden S, Wingo PA. Cancer statistics, 2000. CA Cancer J Clin. 2000; 50: 7-33.

5j Hall MC, Womack S, Sagalowsky AI, Carmody T, Erickstad MD, Roehrborn CG. Prognostic factors, recurrence, and survival in transitional cell carcinoma of the upper urinary tract: a 30-year experience in 252 patients. Urology. 1998; 52: 594-601.

6j ‹e’n‰hŽŸC‘ĺ‰ĆŠîŽkDt᱔AŠÇŽîᇁCƒxƒbƒhƒTƒCƒh”ĺ”AŠí‰ČŠwi‰ü’ů‘ć‚S”ŁjC‹g“cCiŠÄjD“ě]“°C“Œ‹žC2013.

7j

8j McLaughlin JK, Silverman DT, Hsing AW, et al. Cigarette smoking and cancers of the renal pelvis and ureter. Cancer Res. 1992; 52: 254-7.

9j Brenner DW, Schellhammer PF. Upper tract urothelial malignancy after cyclophosphamide therapy: a case report and literature review. J Urol. 1987; 137: 1226-7.

10j McCredie M, Stewart JH, Carter JJ, Turner J, Mahony JF. Phenacetin and papillary necrosis: independent risk factors for renal pelvic cancer. Kidney Int. 1986; 30: 81-4.

11j Nortier JL, Martinez MC, Schmeiser HH, et al. Urothelial carcinoma associated with the use of a Chinese herb iAristolochia fangchij. N Engl J Med. 2000; 342: 1686-92.

12j Petković SD. Epidemiology and treatment of renal pelvic and ureteral tumors. J Urol. 1975; 114: 858-65.

13j Radovanović Z, Krajinović S, Janković S, Hall PW, Petković S. Family history of cancer among cases of upper urothelial tumours in a Balkan nephropathy area. J Cancer Res Clin Oncol. 1985; 110: 181-3.

14j Habuchi T. Origin of multifocal carcinomas of the bladder and upper urinary tract: molecular analysis and clinical implications. Int J Urol. 2005; 12: 709-16.


CQ1
‹i‰Œ‚đŠÜ‚ߐtṁE”AŠÇŠŕ‚ĚŠëŒŻˆöŽq‚ɂ͂ǂ̂悤‚Č‚ŕ‚Ě‚Ş‚ ‚é‚Š?

Answer

‹i‰Œ‚â–F‘°ƒAƒ~ƒ“‚̐E‹ĆŤ”˜˜I‚ÍäNă÷Šŕ‚Ć‹¤’Ę‚ĚŠëŒŻˆöŽq‚Ĺ‚ ‚éBtṁE”AŠÇŠŕ‚É“Á’Ľ“I‚ČŠëŒŻˆöŽq‚ɂ̓tƒFƒiƒZƒ`ƒ“‚âƒAƒŠƒXƒgƒƒLƒAŽ_‚Č‚Ç‚Ě”˜˜I‚Ş‚ ‚éB

‰đ ŕ

‘˝‚­‚̊‹ŤˆöŽq‚ސtṁE”AŠÇŠŕ‚Ě”­ś‚ÉŠÖ—^‚ľ‚Ä‚˘‚é1j|3jB‹i‰Œ‚â–F‘°ƒAƒ~ƒ“‚̐E‹ĆŤ”˜˜I‚ÍäNă÷Šŕ‚Ć‹¤’Ę‚ĚŠëŒŻˆöŽq‚Ĺ‚ ‚éBƒtƒFƒiƒZƒ`ƒ“Cƒoƒ‹ƒJƒ“tÇiBalkan nephropathyjCŠż•ű–ňtÇ‚Ȃǂ́CtṁE”AŠÇŠŕ‚Ě”­ś‚É“Á’Ľ“I‚Ĺ‚ ‚é2j3jB‰đ”ME’Á’É–ň‚Ĺ‚ ‚éƒtƒFƒiƒZƒ`ƒ“C–F‘°ƒAƒ~ƒ“‚Ĺ‚ ‚éƒxƒ“ƒWƒWƒ“‚âƒŔ-ƒiƒtƒ^ƒŒƒ“‚Č‚Ç‚Í‚ˇ‚Ĺ‚É‘˝‚­‚̍‘‚Ĺ‹ÖŽ~‚ł‚ę‚Ä‚˘‚é‚ŞC‹i‰Œ‚â–F‘°ƒAƒ~ƒ“‚̐E‹ĆŤ”˜˜I‚͈ˑR‚Ć‚ľ‚ÄŽĺ—v‚ČŠëŒŻˆöŽq‚Ć‚Č‚Á‚Ä‚˘‚é1j|5jB‹i‰Œ‚ÍĹ‚ŕd—v‚ȐtṁE”AŠÇŠŕ‚ĚŠëŒŻˆöŽq‚ŁC‹i‰ŒŽŇ‚Í”ń‹i‰ŒŽŇ‚Ć”ä‚ׂR”{‚̐tṁE”AŠÇŠŕ‚Ě”­ÇƒŠƒXƒN‚đ—L‚ľC’ˇŠú‚Ě‹i‰ŒŽŇi45 ”NˆČăj‚É‚¨‚˘‚Ä‚Í‚ť‚ĚƒŠƒXƒN‚Ş7.2”{‚É‘‰Á‚ˇ‚é‚Ć•ń‚ł‚ę‚Ä‚˘‚é1jB‰ß‹Ž‚É‹i‰Œ—đ‚đ—L‚ˇ‚銳ŽŇ‚É‚¨‚˘‚Ä‚ŕC”ń‹i‰ŒŽŇ‚Ć”ä‚ׂQ”{‚ĚƒŠƒXƒN‚đ—L‚ˇ‚é‚Ć‚˘‚í‚ę‚Ä‚˘‚éB–F‘°ƒAƒ~ƒ“‚É‚ć‚étṁE”AŠÇŠŕ‚Ě”­ś‚ɂ́C–ń‚V”N‚Ě”˜˜I‚Ş•K—v‚Ć‚ł‚ęC20”N’ö“x‚̐ö•šŠúŠÔ‚Ş‚ ‚é‚Ć‚ł‚ę‚Ä‚˘‚é2j|4jB

ƒAƒŠƒXƒgƒƒLƒAŽ_‚đŠÜ‚ސA•¨‚ސś‘§‚ˇ‚éƒoƒ‹ƒJƒ“”ź“‡“Á—L‚Ě•—“y•a‚Ĺ‚ ‚éƒoƒ‹ƒJƒ“tÇ‚âC‘ä˜p‚É‚¨‚Ż‚éƒAƒŠƒXƒgƒƒLƒAŽ_‚đŠÜ‚ŢŠż•ű–ň‘‚É‚ć‚銿•ű–ňtÇ‚ށCtṁE”AŠÇŠŕ‚Ě”­ś‚ÉŠÖ˜A‚ľ‚Ä‚˘‚é‚ą‚Ć‚ŞŽŚ‚ł‚ę‚Ä‚˘‚é6j|10jBŠż•ű–ňtÇ‚ɂ‚˘‚ẮC‘“ŕ‚ŏł”F‚ł‚ę‚˝ś–ňi–ؒʁC–h›ßC×hC–؍j‚Ĺ‚Í–â‘č‚Ć‚Č‚ç‚Č‚˘‚ŕ‚̂́C“nqć‚Ĺ‚Ěw“ü‚âƒlƒbƒg”Ě”„‚É‚ć‚éŒÂl—A“ü‚ĚŰ‚ÉCƒAƒŠƒXƒgƒƒLƒAŽ_‚ĚŠÜ—L‚Ş‹^‚í‚ę‚鐜–ň‚đ—p‚˘‚˝ťÜ‚đw“ü‚ľ‚Ä•ž—p‚ˇ‚é‰Â”\Ť‚Ş‚ ‚é‚ą‚Ć‚Š‚çC’ˆÓŠŤ‹N‚ł‚ę‚Ä‚˘‚é11jBƒAƒŠƒXƒgƒƒLƒAŽ_‚Ě‘ăŽÓ•¨‚͐t”玿‚ɏWĎ‚ľt“ŐŤ‚â‹­‚˘”­ŠŕŤ‚đŽŚ‚ˇ‚ށCƒAƒŠƒXƒgƒ‰ƒNƒ^ƒ€-DNA•t‰Á‘Ě‚đŒ`Ź‚ľCTP53 ˆâ“`Žq‚Ě“Ë‘R•ĎˆŮ‚đ‚ŕ‚˝‚炡‚ą‚Ć‚Ş’m‚ç‚ę‚Ä‚˘‚éB‚ą‚Ě•ĎˆŮ‚Ě‘˝‚­‚̓AƒŠƒXƒgƒƒLƒAŽ_‚ĆŠÖ˜AŤ‚Ě‚Č‚˘tṁE”AŠÇŠŕ‚Ě•ĎˆŮ—lŽŽ‚Ć‚ÍˆŮ‚Č‚Á‚Ä‚˘‚é6j|8jB‘ä˜p‚̓쐟•”ŠCŠÝ’n•ű‚̏Z–Ż‚ɂ͐tṁE”AŠÇŠŕ‚ލ‚—Ś‚É”­ś‚ľ‚Ä‚˘‚é‚ą‚Ć‚Ş’m‚ç‚ę‚Ä‚˘‚é2j3j8jB‚ą‚Ě’n•ű‚̏Z–Ż‚ɂ͍•‘Ť•aiblackfoot diseasej‚⍂ƒŒƒxƒ‹‚Ěƒq‘f‚Ö‚Ě”˜˜I‚ŕ”F‚ß‚Ä‚˘‚é‚ŞC‚ą‚ę‚ç‚ŞtṁE”AŠÇŠŕ‚ĚŠëŒŻˆöŽq‚Ĺ‚ ‚é‚Š‚ɂ‚˘‚Ä‚Í–ž‚ç‚Š‚Ĺ‚Í‚Č‚˘2j8j12jB

”­Šŕ•¨Žż‚ɑ΂ˇ‚éˆâ“`“IŠ´ŽóŤ‚Ě‘Šˆá‚Ş”A˜Hă”çŠŕ‚Ě”­ś‚ÉŠÖ—^‚ľ‚Ä‚˘‚é‰Â”\Ť‚ŕŽw“E‚ł‚ę‚Ä‚˘‚é2jB‚Ü‚˝”A˜Hă”çŠŕ‚É‚Í”­ś•”ˆĘ“Á—L‚Ě”­Šŕ‹@\‚Ş‘śÝ‚ˇ‚é‰Â”\Ť‚ŕl‚Ś‚ç‚ę‚Ä‚˘‚éBˆâ“`Žq‘˝Œ^‚Í”­Šŕ‚⑝B‚Ć‚ŕŠÖŒW‚ˇ‚é‚ą‚Ć‚Š‚çC”­ŠŕˆöŽq‚ɑ΂ˇ‚éˆâ“`“IŠ´ŽóŤ‚Ćˆâ“`Žq‘˝Œ^‚މđÍ‚ł‚ę‚Ä‚˘‚éBtṁE”AŠÇŠŕ‚É“Á’Ľ“I‚Čˆâ“`Žq‘˝Œ^‚Ş‚Q‚•ń‚ł‚ę‚Ä‚˘‚é13j14jB

ŽQl•śŒŁ

1j McLaughlin JK, Silverman DT, Hsing AW, et al. Cigarette smoking and cancers of the renal pelvis and ureter. Cancer Res. 1992; 52: 254-7.

2j Colin P, Koenig P, Ouzzane A, et al. Environmental factors involved in carcinogenesis of urothelial cell carcinomas of the upper urinary tract. BJU Int. 2009; 104: 1436-40.

3j Rouprêt M, Babjuk M, Compérat E, et al. European guidelines on upper tract urothelial carcinomas: 2013 update. Eur Urol. 2013; 63: 1059-71.

4j Shinka T, Miyai M, Sawada Y, Inagaki T, Okawa T. Factors affecting the occurrence of urothelial tumors in dye workers exposed to aromatic amines. Int J Urol. 1995; 2: 243-8.

5j Pommer W, Bronder E, Klimpel A, Helmert U, Greiser E, Molzahn M. Urothelial cancer at different tumour sites: role of smoking and habitual intake of analgesics and laxatives. Results of the Berlin Urothelial Cancer Study. Nephrol Dial Transplant. 1999; 14: 2892-7.

6j Grollman AP, Shibutani S, Moriya M, et al. Aristolochic acid and the etiology of endemic iBalkanj nephropathy. Proc Natl Acad Sci U S A. 2007; 104: 12129-34.

7j Jelaković B, Karanović S, Vuković-Lela I, et al. Aristolactam-DNA adducts are a biomarker of environmental exposure to aristolochic acid. Kidney Int. 2012; 81: 559-67.

8j Chen CH, Dickman KG, Moriya M, et al. Aristolochic acid-associated urothelial cancer in Taiwan. Proc Natl Acad Sci U S A. 2012; 109: 8241-6.

9j Nortier JL, Martinez MC, Schmeiser HH, et al. Urothelial carcinoma associated with the use of a Chinese herb iAristolochia fangchij. N Engl J Med. 2000; 342: 1686-92.

10j Laing C, Hamour S, Sheaff M, Miller R, Woolfson R. Chinese herbal uropathy and nephropathy. Lancet. 2006; 368: 338.

11j

12j Wang YH, Yeh SD, Wu MM, et al. Comparing the joint effect of arsenic exposure, cigarette smoking and risk genotypes of vascular endothelial growth factor on upper urinary tract urothelial carcinoma and bladder cancer. J Hazard Mater. 2013; 262: 1139-46.

13j Rouprêt M, Cancel-Tassin G, Comperat E, et al. Phenol sulfotransferase SULT1A1*2 allele and enhanced risk of upper urinary tract urothelial cell carcinoma. Cancer Epidemiol Biomarkers Prev. 2007; 16: 2500-3.

14j Rouprêt M, Drouin SJ, Cancel-Tassin G, Comperat E, Larré S, Cussenot O. Genetic variability in 8q24 confers susceptibility to urothelial carcinoma of the upper urinary tract and is linked with patterns of disease aggressiveness at diagnosis. J Urol. 2012; 187: 424-8.


CQ2
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Answer

”A˜Hă”çŠŕ‚Í”A˜H“ŕo‘S‘Ě‚É‹óŠÔ“ICŽžŠÔ“I‚É‘˝”­‚ˇ‚é“Á’Ľ‚đ—L‚ˇ‚éBtṁE”AŠÇŠŕŽĄ—ĂŒăC30~50%‚ÉäNă÷Šŕ‚Ş”­ś‚ˇ‚é‚Ć‚ł‚ę‚Ä‚˘‚éBćsŤ‚ÉäNă÷Šŕ‚ĚŠů‰‚đ—L‚ˇ‚éę‡C‚ ‚邢‚Í“ŻŽžŤäNă÷Šŕ‚đ”F‚ß‚éę‡‚ŕ­‚Č‚­‚Č‚˘BtṁE”AŠÇŠŕ‚ÍäNă÷Šŕ‚Ć–§Ú‚ÉŠÖ˜A‚ˇ‚éB

‰đ ŕ

”A˜Hă”çŠŕ‚͐tṁC”AŠÇCäNă÷C”A“š‚đŠÜ‚ß‚˝”A˜H“ŕo‘S‘Ě‚É‹óŠÔ“ICŽžŠÔ“I‚É‘˝”­‚ˇ‚é“Á’Ľ‚đ—L‚ˇ‚éBtṁE”AŠÇ“ŕo‚ÉˆŮŠŤ‚É‘˝”­‚ˇ‚éę‡CćsŤ‚ÉäNă÷Šŕ‚ĚŠů‰‚đ—L‚ˇ‚éę‡C‚ ‚邢‚͐tṁE”AŠÇŠŕf’fŽž‚É“ŻŽž‚ÉäNă÷Šŕ‚đ”F‚ß‚éę‡‚ŕ­‚Č‚­‚Č‚˘BŽŔŰCtṁE”AŠÇŠŕ‚ɐćs‚ľ‚ÄäNă÷Šŕ‚ĚŠů‰‚đ—L‚ˇ‚銄‡‚Í10~20%C“ŻŽžŤäNă÷Šŕ‚đ”F‚߂銄‡‚Í8.5~13%‚Ć•ń‚ł‚ę‚Ä‚˘‚é1j|3jB2013 ”NEAU ƒKƒCƒhƒ‰ƒCƒ“‚ł́C„§ƒOƒŒ[ƒhA ‚Ć‚ľ‚āutṁE”AŠÇŠŕ‚̐f’fŽž‚ɂ́C“ŻŽžŤäNă÷Šŕ‚ĚŒŸő–Ú“I‚ĚäNă÷‹žŒŸ¸‚Ş•K—vv‚Ć‚ł‚ę‚Ä‚˘‚é4jB‚Ü‚˝äNă÷Šŕ‚ĚŠů‰‚đ—L‚ł‚Č‚˘ę‡‚Ĺ‚ŕCtṁE”AŠÇŠŕ‚̏pŒă‚ÉäNă÷Šŕ‚Ş”­śiÄ”­j‚ˇ‚é•p“x‚Í30~50%‚Ć”äŠr“I‚‚­CpŒă‚Q”NˆČ“ŕ‚ɐś‚ś‚é‚ą‚Ć‚Ş‘˝‚˘‚Ć‚ł‚ę‚Ä‚˘‚é5j|7jB

ˆę•űC‹Ř‘w”ńZŤäNă÷Šŕ‚ĚŽĄ—ĂŒă10 ”NˆČ“ŕ‚ɐtṁE”AŠÇŠŕ‚đ”F‚ß‚é•p“x‚Í2`4%‚Ć”äŠr“I‹H‚Ĺ‚ ‚é8j9jB‚ą‚Ě‚˝‚߁Clow grade‹Ř‘w”ńZŤäNă÷ŠŕÇ—á‚É‚¨‚˘‚āCă•””A˜H‚Ě’čŠú“I‚Ȑ¸¸‚Ě—v”ۂɂ‚˘‚Ă͈ӌŠ‚Ş•Ş‚Š‚ę‚Ä‚˘‚é10jB‚ľ‚Š‚ľCE‹ĆŤäNă÷ŠŕÇ—á‚âäNă÷ă”ç“ŕŠŕÇ—áCäNă÷ŽOŠp•”‚ÉˆĘ’u‚ˇ‚éŽîᇂł͐tṁE”AŠÇŠŕ‚đ‡•š‚ˇ‚é—Ś‚ލ‚‚­‚Č‚é“_‚Í—ŻˆÓ‚Ş•K—v‚Ĺ‚ ‚é11j|13jB‹ÇŠZŤäNă÷Šŕ‚Ěę‡Cf’fŽž‚ɐtṁE”AŠÇŠŕ‚̍‡•š‚Ě—L–ł‚đŒŸő‚ˇ‚é‚ą‚Ć‚Íd—v‚Ĺ‚ ‚éB‚Ü‚˝‰ć‘œăˆŮíŠŒŠ‚đ”F‚ß‚Č‚˘ę‡‚É‚¨‚˘‚Ä‚ŕC”AŠÇ’f’[‚ɏă”ç“ŕŠŕ‚đ”F‚߂銄‡‚Í–ń5~10%‚Ć•ń‚ł‚ę‚Ä‚˘‚é14j15jBˆę•űCp’†v‘Ź•a—ŒŸ¸‚É‚ć‚č”AŠÇ’f’[‚̏ă”ç“ŕŠŕ‚Ě—L–ł‚đŒŸ“˘‚ˇ‚é‚ą‚Ć‚ĚˆÓ‹`‚Í‚Í‚Á‚Ť‚č‚Ć‚ľ‚Ä‚˘‚Č‚˘B

tṁE”AŠÇŠŕ‚ÉäNă÷Šŕ‚Ş•š”­‚ľ‚₡‚˘‹@˜‚Ć‚ľ‚ẮCŠŕ×–E‚Ü‚˝‚ÍŠŕ‘O‹ě×–E‚Ş”A‚Ě—Ź‚ę‚ɏć‚Á‚Ä”dŽí‚ˇ‚é‚Ć‚˘‚¤ŕ‚âC”A’†•ĎˆŮŒ´Ť•¨Žż‚É‚ć‚č”A˜H‘S‘Ě‚Ş”˜˜I‚đ‚¤‚Ż‚é‚Ć‚˘‚¤ŕ‚Ş‚ ‚éBˆâ“`Žq”­Œť‚âˆâ“`Žq•ĎˆŮCƒ}ƒCƒNƒƒTƒeƒ‰ƒCƒgƒ}[ƒJ[“™‚đ—p‚˘‚˝Œ¤‹†‚Ş‚Č‚ł‚ę‚Ä‚˘‚é‚ŞC–˘‚žˆę’č‚ĚŒŠ‰đ‚Í“ž‚ç‚ę‚Ä‚˘‚Č‚˘5j16j17jB

ŽQl•śŒŁ

1j Milojevic B, Djokic M, Sipetic-Grujicic S, et al. Prognostic significance of nonmuscle-invasive bladder tumor history in patients with upper urinary tract urothelial carcinoma. Urol Oncol. 2013; 31: 1615-20.

2j Raman JD, Ng CK, Boorjian SA, Vaughan ED Jr., Sosa RE, Scherr DS. Bladder cancer after managing upper urinary tract transitional cell carcinoma: predictive factors and pathology. BJU Int. 2005; 96: 1031-5.

3j Hagiwara M, Kikuchi E, Tanaka N, et al. Impact of smoking status on bladder tumor recurrence after radical nephroureterectomy for upper tract urothelial carcinoma. J Urol. 2013; 189: 2062-8.

4j Rouprêt M, Babjuk M, Compérat E, et al. European guidelines on upper tract urothelial carcinomas: 2013 update. Eur Urol. 2013; 63: 1059-71.

5j Habuchi T. Origin of multifocal carcinomas of the bladder and upper urinary tract: molecular analysis and clinical implications. Int J Urol. 2005; 12: 709-16.

6j Hirano D, Okada Y, Nagane Y, et al. Intravesical recurrence after surgical management of urothelial carcinoma of the upper urinary tract. Urol Int. 2012; 89: 71-7.

7j Takaoka E, Hinotsu S, Joraku A, et al. Pattern of intravesical recurrence after surgical treatment for urothelial cancer of the upper urinary tract: a single institutional retrospective long-term follow-up study. Int J Urol. 2010; 17: 623-8.

8j Millán-Rodriguez F, Chéchile-Toniolo G, Salvador-Bayarri J, Huguet-Pérez J, Vicente-Rodriguez J. Upper urinary tract tumors after primary superficial bladder tumors: prognostic factors and risk groups. J Urol. 2000; 164: 1183-7.

9j Herr HW, Cookson MS, Soloway SM. Upper tract tumors in patients with primary bladder cancer followed for 15 years. J Urol. 1996; 156: 1286-7.

10j Bajaj A, Sokhi H, Rajesh A. Intravenous urography for diagnosing synchronous upper-tract tumours in patients with newly diagnosed bladder carcinoma can be restricted to patients with high-risk superficial disease. Clin Radiol. 2007; 62: 854-7.

11j Shinka T, Uekado Y, Aoshi H, Hirano A, Ohkawa T. Occurrence of uroepithelial tumors of the upper urinary tract after the initial diagnosis of bladder cancer. J Urol. 1988; 140: 745-8.

12j Solsona E, Iborra I, Ricós JV, Monrós JL, Dumont R, Almenar S. Extravesical involvement in patients with bladder carcinoma in situ: biological and therapy implications. J Urol. 1996; 155: 895-9.

13j Palou J, Rodriguez-Rubio F, Huguet J, et al. Multivariate analysis of clinical parameters of synchronous primary superficial bladder cancer and upper urinary tract tumor. J Urol. 2005; 174: 859-61.

14j Silver DA, Stroumbakis N, Russo P, Fair WR, Herr HW. Ureteral carcinoma in situ at radical cystectomy: does the margin matter? J Urol. 1997; 158: 768-71.

15j Nakanishi S, Nishiyama H, Ito M, Yoshimura K, Kamoto T, Ogawa O. Management of concomitant ureteral carcinoma in situ at radical cystectomy. Int J Urol. 2006; 13: 524-8.

16j Takahashi T, Habuchi T, Kakehi Y, et al. Clonal and chronological genetic analysis of multifocal cancers of the bladder and upper urinary tract. Cancer Res. 1998; 58: 5835-41.

17j Miyake H, Hara I, Kamidono S, Eto H. Multifocal transitional cell carcinoma of the bladder and upper urinary tract: molecular screening of clonal origin by characterizing CD44 alternative splicing patterns. J Urol. 2004; 172: 1127-9.


Ⅱ f’f

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Ⅲ ”A×–EfŒŸ¸C‹tsŤt᱔AŠÇ‘˘‰eŒŸ¸

2013 ”NEAU ƒKƒCƒhƒ‰ƒCƒ“‚ł́C”A×–EfŒŸ¸‚͐tṁE”AŠÇŠŕ‚̐f’f‚É‚¨‚˘‚Đ„§ƒOƒŒ[ƒhA‚Ć•\‹L‚ł‚ę‚Ä‚˘‚é6jBŽŠ‘R”A‚Ĺ‚Ě”A×–Ef‚Ş—zŤ‚Ěę‡CäNă÷‹žŠŒŠ‚Ĺ“Á‹L‚ˇ‚ׂŤˆŮíŠŒŠ‚Ş‚Č‚­C‚ł‚ç‚ÉäNă÷‚â‘O—§‘B‚̏ă”ç“ŕŠŕiCISj‚ސśŒŸ“™‚ŏœŠO‚ł‚ę‚ę‚ΐtṁE”AŠÇŠŕ‚Ş‹^‚í‚ę‚é13jB‚ľ‚Š‚ľChigh grade Šŕ‚Ĺ‚ ‚Á‚Ä‚ŕCäNă÷Šŕ‚Ć”ä‚ׁCtṁE”AŠÇŠŕ‚̐f’f‚É‚¨‚Ż‚é”A×–Ef‚ĚŠ´“x‚͈ę”Ę“I‚ɒႢ‚Ć‚ł‚ę14jCstaging ‚Ć‚Ě‘ŠŠÖ‚ŕ’Ⴂ‚Ć‚ł‚ę‚Ä‚˘‚é6jB

CT ‚ ‚邢‚ÍMRI ‚Č‚Ç‚Ě‰ć‘œŒŸ¸‚ލs‚í‚ę‚˝ă‚Ĺ‚Ě‹tsŤt᱔AŠÇ‘˘‰eŒŸ¸‚̐f’f“IˆÓ‹`‚Í’á‚­C2013 ”NEAU ƒKƒCƒhƒ‰ƒCƒ“‚Ĺ‚Í‹tsŤt᱔AŠÇ‘˘‰eŒŸ¸‚͐„§ƒOƒŒ[ƒhC ‚Ć•\‹L‚ł‚ę‚Ä‚˘‚é6jBtṁE”AŠÇŠŕ‚É‚¨‚˘‚āC”AŠÇƒJƒe[ƒeƒ‹–@‚É‚ć‚čĚŽć‚ł‚ę‚˝t᱔AŠÇ”A‚â”AŠÇ‹ž‰ş‚Ĺ’źÚĚŽć‚ł‚ę‚˝”A‚đ—p‚˘‚˝”A×–Ef‚ĚŠ´“x‚Í40~70%‚Ĺ‚ ‚č15j16jC“Á‚Élow grade Šŕ‚ɑ΂ˇ‚é‹U‰AŤ—Ś‚Í50%‚ƍ‚‚˘ˆę•ű‚Ĺ17jChigh grade Šŕ‚ɑ΂ˇ‚鐳f—Ś‚Í75%‚Ĺ‚ ‚Á‚˝‚Ć•ń‚ł‚ę‚Ä‚˘‚é18jB”AŠÇƒJƒe[ƒeƒ‹–@‚É‚ÄŽîᇂ̋ߖT‚ć‚č”A‚đĚŽć‚ˇ‚éę‡CĚŽć‚ľ‚˝×–E‚ĚŒ`‘Ô‚đ•Ű‚‚˝‚߂ɁC‘˘‰eÜ‚đ’“ü‚ˇ‚é‘O‚ÉŒŸ‘ĚĚŽć‚Ş–]‚Ü‚ľ‚˘‚ą‚Ć‚ć‚čC‹ß”N‚Ě•ń‚ł́C”AŠÇƒJƒe[ƒeƒ‹‚â”AŠÇ‹ž‚đ‰î‚ľ‚Ä‚Ě‹tsŤt᱔AŠÇ‘˘‰eŒŸ¸‚́C‘I‘𐍔A×–Ef‚ĚŒŸ‘̮̍ć‚É•t‚ľ‚˝ƒIƒvƒVƒ‡ƒ“‚̂ЂƂ‚ɉ߂Ź‚Č‚˘‚Ć‚ł‚ę‚Ä‚˘‚é19jB‚ľ‚Š‚ľC‘˘‰eÜƒAƒŒƒ‹ƒM[‚Ş‚ ‚é‚Č‚Ç‚ĹCTCMRI ‚ŞŽ{s‚Ĺ‚Ť‚Č‚˘ę‡‚â”AŠÇ‹ž‚Ě‘}“ü‚ލ˘“ď‚ČÇ—á‚Ȃǂł́C‹tsŤt᱔AŠÇ‘˘‰eŒŸ¸‚̐tṁE”AŠÇŠŕ‚̐f’f“I‰ż’l‚͍‚‚˘‚ƍl‚Ś‚ç‚ę‚éB

Ⅳ ‰ć‘œŒŸ¸C”A×–EfŒŸ¸C”AŠÇ‹žŒŸ¸‚đ•Ą‡“I‚É‘g‚ݍ‡‚í‚š‚˝•a—•aŠú—\‘Ş‚Ě‰Â”\Ť

‰ć‘œŠŒŠC”A×–EfC‚Ü‚˝”AŠÇ‹ž‰şŽîᇐśŒŸiCQ4 ŽQĆj‚ť‚ę‚ź‚ę’P“Ć‚Ě•]‰ż‚͐łŠm‚ȐtṁE”AŠÇŠŕ‚̐[’B“xf’fE—\‘Ş‚É•s\•Ş‚Ĺ‚ ‚éB‚ť‚ą‚Ĺ‚ą‚ę‚ç‚ĚŒŸ¸‚đ•Ą‡“I‚É‘g‚ݍ‡‚í‚š‚é‚ą‚Ć‚É‚ć‚éC•a—•aŠú•]‰żE—\‘Ş‚ĚŒüă‚ĚŽŽ‚Ý‚Ş‚Č‚ł‚ę‚Ä‚˘‚éBt”AŠÇ‘S“EœpEäNă÷•”•ŞŘœp‚đŽ{s‚ľ‚˝tṁE”AŠÇŠŕ659 —á‚đ—p‚˘‚˝Œă‚ëŒü‚ŤŒ¤‹†‚ł́CŽîá‡gradeihigh grade vs low gradejCŽîᇂ̌`óisessile vs papillaryjCŽîᇂ̋Ǎ݁irenal pelvis vs ureterj‚Í”ńŒŔ‹ÇŤŠŕ‚Ě‘śÝ‚Ć—LˆÓ‚ÉŠÖ˜A‚ľ‚Ä‚¨‚čC‚ą‚ę‚ç‚Ě‚R‚Â‚ĚˆöŽq‚đ—p‚˘‚˝p‘Oƒmƒ‚ƒOƒ‰ƒ€‚đěŹ‚ˇ‚é‚ą‚ƂŁC76.6%‚̐¸“x‚Ĺ”ńŒŔ‹ÇŤŠŕ‚đ—\‘Ş‚Ĺ‚Ť‚é‚ą‚Ć‚Š‚çCp‘O‚Ě”AŠÇ‹ž‚É‚ć‚éŽîᇂ̌`ó‚ĚŠĎŽ@CŽîᇐśŒŸ‚É‚ć‚étumor gradingC‚ł‚ç‚ÉŽîᇕ”ˆĘ‚Ě•]‰ż‚đŠŠ‚ß‚Ä‚˘‚é20jB‚Ü‚˝Ct”AŠÇ‘S“EœpEäNă÷•”•ŞŘœp‚đŽ{s‚ľ‚˝tṁE”AŠÇŠŕ274 —á‚đ‘ÎŰ‚ÉC”AŠÇ‹ž‰şŽîᇐśŒŸ‚ ‚邢‚Í”A×–Ef‚É‚ć‚étumor grading ‚¨‚ć‚ŃCT/MRI ŠŒŠ‚ƁC“Eo•W–{‚Ě•a—‘gDŠŒŠ‚Ć‚ĚŠÖ˜AŤ‚đŒă‚ëŒü‚Ť‚ÉŒŸ“˘‚ľ‚˝Œ¤‹†‚ł́C”AŠÇ‹ž‰şŽîᇐśŒŸ‚ ‚邢‚Í”A×–Ef‚É‚Ähigh grade ‚ŁC‰ć‘œ‚ɂċǏŠZ‘œ‚đ’ć‚ľ‚˝ę‡‚́C—LˆÓ‚É‹Ř‘wZŤŠŕ‚¨‚ć‚Ń”ńŒŔ‹ÇŤŠŕ—\‘Ş‚Ěłf—Ś‚ŞŒüă‚ˇ‚é‚Ć‚ł‚ę‚Ä‚˘‚é21jB“Ż—l‚ɁCt”AŠÇ‘S“Eœp‚ ‚邢‚Í”AŠÇŘœp‚đŽ{s‚ľ‚˝tṁE”AŠÇŠŕ172 —á‚đ‘ÎŰ‚É•a—•aŠú—\‘Ş‚đ‰Â”\‚Ć‚ˇ‚ép‘OˆöŽq‚đŒŸ“˘‚ľ‚˝Œă‚ëŒü‚ŤŒ¤‹†‚ł́Cp‘O…tÇ‚Ě‘śÝC”AŠÇ‹ž‰şŽîᇐśŒŸ‚Ĺ‚Ěhigh gradeC”A×–Ef—zŤ‚Ě‚RˆöŽq‚ˇ‚ׂĂޗzŤ‚Ěę‡‚́C89%‚Ş‹Ř‘wZŤŠŕC73%‚Ş”ńŒŔ‹ÇŤŠŕ‚Ĺ‚ ‚Á‚˝‚̂ɑ΂ľ‚āC‚ą‚ę‚ç‚RˆöŽq‚Ě‚ˇ‚ׂĂމAŤ‚Ĺ‚ ‚Á‚˝ę‡‚́C‹Ř‘wZŤŠŕ‚ ‚邢‚Í”ńŒŔ‹ÇŤŠŕ‚Í”F‚ß‚ç‚ę‚Č‚Š‚Á‚˝‚Ć•ń‚ľ‚Ä‚˘‚é22jB

ˆČă‚ć‚čC”AŠÇ‹ž‰şŽîᇐśŒŸ‚ɁC‰ć‘œŠŒŠi—Տ°Šw“I[’B“xC…tÇ‚Ě—L–ł“™j‚â”A×–EfŒŸ¸‚đ•š—p‚ˇ‚é‚ą‚ƂŁC‚ć‚萳Šm‚Č•a—•aŠú—\‘ނމ”\‚Ć‚Č‚čCŽĄ—Ă•űj‚ĚŒˆ’č‚ÉŠń—^‚ˇ‚é‚ƍl‚Ś‚ç‚ę‚é22j23jB‚ľ‚Š‚ľ‚Č‚Ş‚ç‚ą‚ę‚ç‚Í‚ˇ‚ׂČă‚ëŒü‚ŤŠĎŽ@Œ¤‹†‚Ěƒf[ƒ^WĎ‚Š‚ç“ž‚ç‚ę‚˝Œ‹‰Ę‚Ĺ‚ ‚čC‚Ü‚˝‚ť‚Ě—L—pŤ‚ÉŠÖ‚ľ‚Ä‚ÍŠO•”ŒŸŘ‚ŕ•s\•Ş‚Ĺ‚ ‚éBĄŒă‚ł‚ç‚Ȃ鐸“x‚̍‚‚˘C•a—•aŠú—\‘Ş‚đ‰Â”\‚Ć‚ˇ‚ép‘O—\‘ރVƒXƒeƒ€‚̍\’z‚Ş–]‚Ü‚ę‚éB

ŽQl•śŒŁ

1j Lughezzani G, Jeldres C, Isbarn H, et al. Nephroureterectomy and segmental ureterectomy in the treatment of invasive upper tract urothelial carcinoma: a population-based study of 2299 patients. Eur J Cancer. 2009; 45: 3291-7.

2j Margulis V, Shariat SF, Matin SF, et al. Outcomes of radical nephroureterectomy: a series from the Upper Tract Urothelial Carcinoma Collaboration. Cancer. 2009; 115: 1224-33.

3j Kikuchi E, Margulis V, Karakiewicz PI, et al. Lymphovascular invasion predicts clinical outcomes in patients with node-negative upper tract urothelial carcinoma. J Clin Oncol. 2009; 27: 612-8.

4j Jinzaki M, Matsumoto K, Kikuchi E, et al. Comparison of CT urography and excretory urography in the detection and localization of urothelial carcinoma of the upper urinary tract. AJR Am J Roentgenol. 2011; 196: 1102-9.

5j Wang LJ, Wong YC, Huang CC, Wu CH, Hung SC, Chen HW. Multidetector computerized tomography urography is more accurate than excretory urography for diagnosing transitional cell carcinoma of the upper urinary tract in adults with hematuria. J Urol. 2010; 183: 48-55.

6j Rouprêt M, Babjuk M, Compérat E, et al. European guidelines on upper tract urothelial carcinomas: 2013 update. Eur Urol. 2013; 63: 1059-71.

7j Cowan NC. CT urography for hematuria. Nat Rev Urol. 2012; 9: 218-26.

8j Takahashi N, Kawashima A, Glockner JF, et al. Small i<2-cmj upper-tract urothelial carcinoma: evaluation with gadolinium-enhanced three-dimensional spoiled gradient-recalled echo MR urography. Radiology. 2008; 247: 451-7.

9j Takahashi N, Glockner JF, Hartman RP, et al. Gadolinium enhanced magnetic resonance urography for upper urinary tract malignancy. J Urol. 2010; 183: 1330-65.

10j Thomsen HS, European Society of Urogenital RadiologyiESURj. ESUR guideline: gadolinium-based contrast media and nephrogenic systemic fibrosis. Eur Radiol. 2007; 17: 2692-6.

11j Akita H, Jinzaki M, Kikuchi E, et al. Preoperative T categorization and prediction of histopathologic grading of urothelial carcinoma in renal pelvis using diffusion-weighted MRI. AJR Am J Roentgenol. 2011; 197: 1130-6.

12j Yoshida S, Kobayashi S, Koga F, et al. Apparent diffusion coefficient as a prognostic biomarker of upper urinary tract cancer: a preliminary report. Eur Radiol. 2013; 23: 2206-14.

13j Witjes JA, Redorta JP, Jacqmin D, et al. Hexaminolevulinate-guided fluorescence cystoscopy in the diagnosis and follow-up of patients with non-muscle-invasive bladder cancer: review of the evidence and recommendations. Eur Urol. 2010; 57: 607-14.

14j Messer J, Shariat SF, Brien JC, et al. Urinary cytology has a poor performance for predicting invasive or high-grade upper-tract urothelial carcinoma. BJU Int. 2011; 108: 701-5.

15j Renshaw AA. Comparison of ureteral washing and biopsy specimens in the community setting. Cancer. 2006; 108: 45-8.

16j Williams SK, Denton KJ, Minervini A, et al. Correlation of uppertract cytology, retrograde pyelography, ureteroscopic appearance, and ureteroscopic biopsy with histologic examination of upper-tract transitional cell carcinoma. J Endourol. 2008; 22: 71-6.

17j Sedlock DJ, MacLennan GT. Urine cytology in the evaluation of upper tract urothelial lesions. J Urol. 2004; 172: 2406.

18j Highman WJ. Transitional carcinoma of the upper urinary tract: a histological and cytopathological study. J Clin Pathol. 1986; 39: 297-305.

19j Cowan NC, Turney BW, Taylor NJ, McCarthy CL, Crew JP. Multidetector computed tomography urography for diagnosing upper urinary tract urothelial tumour. BJU Int. 2007; 99: 1363-70.

20j Margulis V, Youssef RF, Karakiewicz PI, et al. Preoperative multivariable prognostic model for prediction of nonorgan confined urothelial carcinoma of the upper urinary tract. J Urol. 2010; 184: 453-8.

21j Favaretto RL, Shariat SF, Savage C, et al. Combining imaging and ureteroscopy variables in a preoperative multivariable model for prediction of muscle-invasive and non-organ confined disease in patients with upper tract urothelial carcinoma. BJU Int. 2012; 109: 77-82.

22j Brien JC, Shariat SF, Herman MP, et al. Preoperative hydronephrosis, ureteroscopic biopsy grade and urinary cytology can improve prediction of advanced upper tract urothelial carcinoma. J Urol. 2010; 184: 69-73.

23j Guarnizo E, Pavlovich CP, Seiba M, Carlson DL, Vaughan ED Jr., Sosa RE. Ureteroscopic biopsy of upper tract urothelial carcinoma: improved diagnostic accuracy and histopathological considerations using a multi-biopsy approach. J Urol. 2000; 163: 52-5.


CQ3
tṁE”AŠÇŠŕ‚̐f’f‚ÉCT urography‚Í—L—p‚Š?

Answer

tṁE”AŠÇŠŕ‚đ‹­‚­‹^‚Á‚˝ę‡‚́CŠŕŒŸo‚Ě‚˝‚ß‚É‚Š‚‚Ă͒´‰š”gC”rŸ•Ť”A˜H‘˘‰e‚Ş‘ćˆę‘I‘đ‚Ć‚ľ‚Ä—p‚˘‚ç‚ę‚Ä‚˘‚˝‚ށCĹ‹ß‚Ĺ‚ÍCT urography ‚đ‚Ü‚¸s‚¤‚ą‚Ć‚Ş„§‚ł‚ę‚éB•aŠúf’f‚ɑ΂ľ‚Ä‚ŕ’ʏíCCT ‚Ş—p‚˘‚ç‚ę‚éB]‚Á‚ÄŒŸoC•aŠúf’f‚Ć‚ŕ‚ÉCT urography ‚Ş‘ćˆę‘I‘đ‚Ć‚ľ‚Ä—p‚˘‚ç‚ę‚éi„§ƒOƒŒ[ƒhBjB

‰đ ŕ

CT urography iCTUj‚Ƃ́CtṁE”AŠÇ‚Ş‘˘‰eÜ‚Ĺ–ž‚˝‚ł‚ę‚é”rŸ•‘Š‚Ě‘œi‘˘‰eÜ“Š—^Œă8~10 •Ş–ځj‚đŠÜ‚߂āC‘˘‰e‘OŒă‚Ě”–‚˘ƒXƒ‰ƒCƒXŒú‚Ĺ”A˜H‚đ•]‰ż‚ľ‚Ä‚˘‚­CT ŒŸ¸‚Ě‚ą‚Ć‚Ĺ‚ ‚é1jB2000 ”N‘ă‚É‚Č‚Á‚Ä‘˝—ńŒŸoŠíCT ‚ސi•ŕ‚ľC”–‚˘ƒXƒ‰ƒCƒXŒú‚Őt‘Ÿ‚Š‚獜”Ő‚Ü‚Ĺ‚Ě”A˜H‘S’ˇ‚đˆę‰ń‚Ě‘§Ž~‚ß‚ĹŽB‰e‚Ĺ‚Ť‚é‚悤‚É‚Č‚Á‚˝‚˝‚߂ɉ”\‚Ć‚Č‚Á‚˝ŒŸ¸‚Ĺ‚ ‚éB‚ť‚ę‚܂ł́CtṁE”AŠÇ•a•Ď‚ĚŒŸo‚́C”rŸ•Ť”A˜H‘˘‰eiintravenous urographyGIVUj‚¨‚ć‚Ń’´‰š”g‚Ş‘ćˆę‘I‘đ‚Ĺ‚ ‚Á‚˝‚ށCCTU ‚Í‚ą‚ę‚ç‚ĚŒŸ¸‚É‘ă‚í‚č“ž‚é”A˜H‚Ě•]‰ż–@‚Ĺ‚ ‚é1j|3jBŒ‹Î‚âtṁE”AŠÇŽîᇁCt“ű“Ş•a•Ď‚â”AŠÇ‚Ě‘–s•ĎˆŮ‚ȂǁC]—ˆ‚ĚIVU ‚Őf’f‚ł‚ę‚Ä‚˘‚˝•a•Ď‚Í‚Ü‚¸f’f‚Ĺ‚Ť‚é‚ą‚Ć‚Í‰Šú‚É•ń‚ł‚ę‚˝2jB‚ť‚ĚŒăCtṁE”AŠÇŠŕ‚̐f’f”\‚đIVU ‚ĆCTU ‚Ĺ”äŠr‚ľ‚˝ŒŸ“˘‚ł́CIVU ‚ĚŠ´“x75.0~80.4%C“ÁˆŮ“x81.0~86.0%C łf—Ś80.8~84.9%‚ɑ΂ľCCTU ‚ÍŠ´“x93.5~95.8%C “ÁˆŮ“x94.8~100%Cłf—Ś94.2~99.6%‚Ć—LˆÓ‚ÉCTU ‚ĚŠŕŒŸo”\‚ލ‚‚˘‚ą‚Ć‚Ş•ń‚ł‚ę‚˝4j5jB‚Ü‚˝C‹tsŤt᱔AŠÇ‘˘‰eŒŸ¸‚Ć”äŠr‚ľ‚Ä‚ŕCTU ‚̐f’f”\‚Í“Ż“™‚Ć‚Ě•ń‚ŕ‚ ‚é6jBCTU ‚Ĺ‹U‰AŤ‚É‚Č‚č“ž‚鏊ŒŠ‚Ć‚ľ‚ẮCă”ç“ŕŠŕC‚Pcm ˆČ‰ş‚̏Ź•a•Ď‚Ş‚ ‚čC‹U—zŤ‚É‚Č‚č“ž‚鏊ŒŠ‚Ć‚ľ‚ẮC—ǐŤŽîᇁC–Ť‰ŠÇCŒŒŽîC”ě‘ĺt“ű“Ş‚Č‚Ç‚Ş‚ ‚é4j|8jB‚Ü‚˝CCTU‚ÍIVU‚Ć”ä‚ׂāC“ŕo‚̏ŠŒŠ‚݂̂Ȃ炸C”A˜H•Ç‚â•ÇŠO‚̏î•ń‚Ş“ž‚ç‚ę‚éCd“x‚̐…tÇÇ—á‚É‚¨‚˘‚Ä‚ŕ•ÂÇ•”ˆĘ‚đ—eˆŐ‚É“Ż’č‚Ĺ‚Ť‚éC“ŻŽž‚É•aŠúf’f‚މ”\C‚Ć‚˘‚Á‚˝—˜“_‚đ—L‚ˇ‚éBˆČă‚ć‚čCtṁE”AŠÇŠŕ‚Ş‹­‚­‹^‚í‚ę‚éÇ—á‚É‚¨‚˘‚Ä‚ÍCTU ‚Ş‘ćˆę‘I‘đŒŸ¸‚ƍl‚Ś‚ç‚ę‚éB‚ľ‚Š‚ľC‘ĚŠi‚É‚ŕ‚ć‚é‚ŞCTU ‚Ě”í‚΂­ü—ʂ́C15~35mSv ’ö“xCIVU ‚Í5~10mSv ’ö“x‚Ć—LˆÓ‚ɍˇ‚Ş‚ ‚č2j|4jC”í‚΂­’ጸ‚ŞCTU ‚̉ۑč‚̂ЂƂ‚ł ‚éBŒťÝC‚ť‚̑Ήžô‚ŞŠˆ—p‚ł‚ęŽn‚ß‚Ä‚˘‚é9jB

tṁE”AŠÇŠŕ‚Ě•aŠúf’f‚ŕCT ‚ŞŠî–{‚Ć‚Č‚éBCT ‚Ě•aŠúf’f‚ÉŠÖ‚ˇ‚é•ń‚͏­‚Č‚˘‚ށC‹ÇŠ[’B“x‚̐¸“x‚́C‘˝—ńŒŸoŠíCT “oęˆČ‘O‚Ĺ‚Í52~59.5%‚Ć•ń‚ł‚ę‚Ä‚˘‚˝‚Ş10j11jC‘˝—ńŒŸoŠíCT ‚ł́C‹Ř‘wZŤŠŕipT2…j•]‰ż‚̐¸“x‚Í66.6%CŽüˆÍ‘ŸŠí‚ւ̐Z‚¨‚ć‚ŃƒŠƒ“ƒpß“]ˆÚipT4 ‚ ‚邢‚ÍN+jf’f‚̐¸“x‚Í96.6%C•aŠúf’f‘S‘̂̐łf—Ś‚Í87.8%‚Ć•ń‚ł‚ę‚Ä‚˘‚é12jBŒ°”÷‹ž“ItŽŔŽżZipT3ajŠŒŠ‚ÍCT ‚É‚¨‚˘‚Ä‹U‰AŤ‚Ć‚Č‚č‚₡‚­CŽüˆÍŽ‰–bD‚̉ŠÇŤ•Ď‰ť‚Í‹U—zŤ‚Ć”ť’f‚ł‚ę‚₡‚˘ŒXŒü‚Ş‚ ‚é12jB

ŽQl•śŒŁ

1j Van Der Molen AJ, Cowan NC, Mueller-Lisse UG, Nolte-Ernsting CC, Takahashi S, Cohan RH. CT urography: definition, indications and techniques. A guideline for clinical practice. Eur Radiol. 2008; 18: 4-17.

2j Caoili EM, Cohan RH, Korobkin M, et al. Urinary tract abnormalities: initial experience with multi-detector row CT urography. Radiology. 2002; 222: 353-60.

3j McTavish JD, Jinzaki M, Zou KH, Nawfel RD, Silverman SG. Multi-detector row CT urography: comparison of strategies for depicting the normal urinary collecting system. Radiology. 2002; 225: 783-90.

4j Jinzaki M, Matsumoto K, Kikuchi E, et al. Comparison of CT urography and excretory urography in the detection and localization of urothelial carcinoma of the upper urinary tract. AJR Am J Roentgenol. 2011; 196: 1102-9.

5j Wang LJ, Wong YC, Huang CC, Wu CH, Hung SC, Chen HW. Multidetector computerized tomography urography is more accurate than excretory urography for diagnosing transitional cell carcinoma of the upper urinary tract in adults with hematuria. J Urol. 2010; 183: 48-55.

6j Cowan NC, Turney BW, Taylor NJ, McCarthy CL, Crew JP. Multidetector computed tomography urography for diagnosing upper urinary tract urothelial tumour. BJU Int. 2007; 99: 1363-70.

7j Wang LJ, Wong YC, Ng KF, Chuang CK, Lee SY, Wan YL. Tumor characteristics of urothelial carcinoma on multidetector computerized tomography urography. J Urol. 2010; 183: 2154-60.

8j Sadow CA, Wheeler SC, Kim J, Ohno-Machado L, Silverman SG. Positive predictive value of CT urography in the evaluation of upper tract urothelial cancer. AJR Am J Roentgenol. 2010; 195: W337-43.

9j Juri H, Matsuki M, Inada Y, et al. Low-dose computed tomographic urography using adaptive iterative dose reduction 3-dimensional: comparison with routine-dose computed tomography with filtered back projection. J Comput Assist Tomogr. 2013; 37: 426-31.

10j Buckley JA, Urban BA, Soyer P, Scherrer A, Fishman EK. Transitional cell carcinoma of the renal pelvis: a retrospective look at CT staging with pathologic correlation. Radiology. 1996; 201: 194-8.

11j Scolieri MJ, Paik ML, Brown SL, Resnick MI. Limitations of computed tomography in the preoperative staging of upper tract urothelial carcinoma. Urology. 2000; 56: 930-4.

12j Fritz GA, Schoellnast H, Deutschmann HA, Quehenberger F, Tillich M. Multiphasic multidetector-row CT iMDCTj in detection and staging of transitional cell carcinomas of the upper urinary tract. Eur Radiol. 2006; 16: 1244-52.


CQ4
tṁE”AŠÇŠŕ‚̐f’f‚É”AŠÇ‹žŒŸ¸‚Í—L—p‚Š?

Answer

tṁE”AŠÇŠŕ‚̐f’f‚É‚¨‚˘‚āC”AŠÇ‹žŒŸ¸‚ÍŠŕŒŸoCŠŕŠm’čf’f‚Ě“_‚Ĺ—L—p‚Ĺ‚ ‚éB‚˝‚ž‚ľC”AŠÇ‹ž‰şŽîᇐśŒŸ‚ĚŠŕŠm’č‚É‚¨‚Ż‚é—zŤ“I’†—Ś‚ÍŒˆ‚ľ‚č‚‚­‚Č‚˘‚˝‚߁C”A×–Ef‚â”AŠÇ‹žŠŒŠ‚ŕŽQl‚É‚ľCĹIf’f‚đs‚¤‚ׂŤ‚Ĺ‚ ‚éi„§ƒOƒŒ[ƒhC1jB

‰đ ŕ

Yazaki ‚ç‚Í‰ć‘œŒŸ¸‚Ĺă•””A˜H‚ɏŠŒŠ‚đ”F‚ß‚Č‚˘Că•””A˜H‚Š‚ç‚ĚŒŒ”A‚ɑ΂ľf’f–Ú“I‚É”AŠÇ‹ž‚đŽ{s‚ľC15 —á‚Ě‚¤‚ż‚T—á‚ɐtṁE”AŠÇŠŕ‚Ş”­ŒŠ‚ł‚ę‚˝‚Ć•ń‚ľ‚Ä‚˘‚é1jBKeeley ‚ç‚É‚ć‚é‚ƁCtṁE”AŠÇŠŕ‚Ş‹^‚í‚ę‚é51 —á‚ɑ΂ľ”AŠÇ‹žŒŸ¸Žž‚É‹zˆř×–Ef‚Ü‚˝‚ÍŽîᇐśŒŸ‚đs‚˘C48 —ái94.1%j‚Ş”A˜Hă”çŠŕ‚Ɛf’f‚ł‚ę‚˝2jB‚ť‚ĚŽîá‡grade ‚Í“Eo‘gD‚Ěgrade‚Ć90%ˆČă‚ވę’v‚ľ‚Ä‚˘‚˝BGuarnizo ‚ç‚Íă•””A˜H•a•ĎiN=45j‚Ě”AŠÇ‹ž‰şŽîᇐśŒŸ‚đs‚˘C40 •a•Ďi89%j‚Ĺă•””A˜HŠŕ‚̐f’f‚đ“ž‚˝3jBf’f‚Ĺ‚Ť‚Č‚Š‚Á‚˝‚T•a•Ď‚Í2~3 ŒÂ‚Ě‚Ý‚Ě•W–{‚đĚŽć‚ľ‚˝‰Šú‚ĚƒP[ƒX‚Ĺ‚ ‚čCŒă‚É‚UŒÂˆČă‚Ě•W–{‚đĚŽć‚ľ‚˝ę‡‚Ĺ‚Í‚ˇ‚×‚Ä‚ĚÇ—á‚Őf’f‰Â”\‚Ĺ‚ ‚Á‚˝‚Ć•ń‚ľ‚Ä‚˘‚éB‚ť‚̐śŒŸ‘gD‚ĚŽîᇠgrade ‚Ć“Eo•W–{‚Ěgrade ‚Í‘ŠŠÖ‚ˇ‚é‚ŞC”AŠÇ‹ž‚ĹTa ‚Ɛf’f‚ľ‚˝22 —á’†10 —ái45%j‚Ş“Eo•W–{‚ĹT1 ˆČă‚Ĺ‚ ‚Á‚˝‚ą‚Ć‚ć‚čC•aŠúf’f‚É‚Í”AŠÇ‹žŒŸ¸‚Í—L—p‚Ĺ‚Í‚Č‚˘‚Ć‚ľ‚Ä‚˘‚éBShiraishi ‚ç‚́C”AŠÇ‹ž‰şŽîᇐśŒŸ‚đ40 —á‚ÉŽ{s‚ľC35 —ái88%j‚ސf’f‰Â”\‚Ĺ‚ ‚čC27 —ái68%j‚đ”A˜Hă”çŠŕ‚Ɛf’f‚ľ‚˝4jB”AŠÇ‹ž‰şśŒŸ‚Ĺ‚ĚŽîá‡grade ‚Í“Eo•W–{‚Ěgrade ‚Ć‘ŠŠÖ‚ľ‚Ä‚˘‚˝Bˆę•űC”AŠÇ‹ž‰şśŒŸ‚ĹŠŕ‚ŞŒŸo‚ł‚ę‚Č‚Š‚Á‚˝‚U—á’†‚Ě‚S—ái67%j‚ɁC‚Ü‚˝f’f•s‰Â”\‚Ĺ‚ ‚Á‚˝‚R—á’†‚P—ái33%j‚É‚¨‚˘‚čŏI“Eo•W–{‚Ĺ”A˜Hă”çŠŕ‚ސf’f‚ł‚ę‚˝BClements ‚ç‚́Cp‘O‚É”AŠÇ‹ž‰şŽîᇐśŒŸ‚đŽ{s‚ľCŒă‚ÉŠO‰Č“I“Eo‚đs‚Á‚˝238 —á‚đ—p‚˘‚Ä‘˝•Ď—ʉđÍ‚đs‚Á‚˝‚Ć‚ą‚ëCśŒŸ‘gD‚ĚŽîá‡grade ‚Í“Eo•W–{‚Ěgrade ‚¨‚ć‚Ń‹Ř‘wZŤŠŕ‚Ć—LˆÓ‚ÉŠÖ˜A‚ľ‚˝‚ށCˆę•ű‚ŐśŒŸ‘gD‚Ĺ‚Ě—Ő°•aŠúiT stagej‚Í‚ą‚ę‚ç‚ĆŠÖ˜A‚đ”F‚ß‚Č‚Š‚Á‚˝‚Ć•ń‚ľ‚Ä‚˘‚é5jBFavaretto‚ç‚́Ct”AŠÇ‘S“EœpEäNă÷•”•ŞŘœp‚ŞŽ{s‚ł‚ę‚˝274 —á‚ĚŒŸ“˘Œ‹‰Ę‚ć‚čCCT ‚âMRI ‚Ĺ‹ÇŠZ‚Ş‹^‚í‚ę‚鏊ŒŠ‚Ć”AŠÇ‹žśŒŸ‚Ěhigh grade Šŕ‚ĚŒŸo‚ށC‹Ř‘wZŤŠŕ‚âT3 ˆČă‚ ‚邢‚̓Šƒ“ƒpß“]ˆÚ‚Č‚Ç‚Ě”ńŒŔ‹ÇŤŠŕ‚đ—\‘Ş‚ˇ‚é“Ć—§‚ľ‚˝ˆöŽq‚Ĺ‚ ‚é‚Ć•ń‚ľ‚Ä‚˘‚é6jBBrien ‚ç‚́C…tÇ‚Ě‘śÝC”AŠÇ‹žśŒŸ‚Ĺ‚Ěhigh gradeC”A×–Ef—zŤ‚Ě‚R—v‘f‚Ş‚ ‚éę‡‚Ě—zŤ“I’†—Ś‚Í‹Ř‘wZŤŠŕ‚ɑ΂ľ‚Ä89%C”ńŒŔ‹ÇŤŠŕ‚ɑ΂ľ‚Ä73%‚Ĺ‚ ‚Á‚˝‚Ć•ń‚ľ‚Ä‚˘‚é7jBPhotodynamic diagnosisiPDDj‚ânarrow band imagingiNBIj‚Şă•””A˜H•a•Ď‚̐f’f‚É—L—p‚Ĺ‚ ‚é‚Ć‚˘‚¤•ń‚ŕŽUŒŠ‚ł‚ę‚é8j9jBˆČă‚ć‚čCŒťŽž“_‚Ĺ‚Í”AŠÇ‹ž‚Ĺ‚ĚŠĎŽ@‚¨‚ć‚ѐśŒŸ’P“Ƃł̐łŠm‚Ȑf’f‚¨‚ć‚ѐ[’B“x‚̐„Ž@‚Í•s\•Ş‚Ĺ‚ ‚čC2013 ”NEAU ƒKƒCƒhƒ‰ƒCƒ“‚É‚¨‚˘‚Ä‚ŕ”AŠÇ‹žŒŸ¸‚͐„§ƒOƒŒ[ƒhC‚Ć‚ł‚ę‚Ä‚˘‚é10jB

”AŠÇ‹žŒŸ¸‚É”ş‚¤ŽîᇔdŽí‚̉”\Ť‚ŞŒœ”O‚ł‚ę‚é‚ŞCHendin ‚ç‚́Cp‘O‚É”AŠÇ‹žŒŸ¸‚đs‚Á‚˝48—á‚ƍs‚í‚Č‚Š‚Á‚˝48 —ái‘ÎĆŒQj‚ɑ΂ľ‚āCŠO‰Č“I“Eo•W–{‚ĚŽîá‡gradeC•a—•aŠúC–łÄ”­ś‘ś—Ś‚đ”äŠrŒŸ“˘‚ľ‚˝‚Ć‚ą‚ëC‚ą‚ę‚ç‚ɍˇ‚đ”F‚ß‚Č‚˘‚Ć•ń‚ľ‚Ä‚˘‚é11jB

ŽQl•śŒŁ

1j Yazaki T, Kamiyama Y, Tomomasa H, et al. Ureteropyeloscopy in the diagnosis of patients with upper tract hematuria: an initial clinical study. Int J Urol. 1999; 6: 219-25.

2j Keeley FX, Kulp DA, Bibbo M, McCue PA, Bagley DH. Diagnostic accuracy of ureteroscopic biopsy in upper tract transitional cell carcinoma. J Urol. 1997; 157: 33-7.

3j Guarnizo E, Pavlovich CP, Seiba M, Carlson DL, Vaughan ED Jr., Sosa RE. Ureteroscopic biopsy of upper tract urothelial carcinoma: improved diagnostic accuracy and histopathological considerations using a multi-biopsy approach. J Urol. 2000; 163: 52-5.

4j Shiraishi K, Eguchi S, Mohri J, Kamiryo Y. Role of ureteroscopic biopsy in the management of upper urinary tract malignancy. Int J Urol. 2003; 10: 627-30.

5j Clements T, Messer JC, Terrell JD, et al. High-grade ureteroscopic biopsy is associated with advanced pathology of upper-tract urothelial carcinoma tumors at definitive surgical resection. J Endourol. 2012; 26: 398-402.

6j Favaretto RL, Shariat SF, Savage C, et al. Combining imaging and ureteroscopy variables in a preoperative multivariable model for prediction of muscle-invasive and non-organ confined disease in patients with upper tract urothelial carcinoma. BJU Int. 2012; 109: 77-82.

7j Brien JC, Shariat SF, Herman MP, et al. Preoperative hydronephrosis, ureteroscopic biopsy grade and urinary cytology can improve prediction of advanced upper tract urothelial carcinoma. J Urol. 2010; 184: 69-73.

8j Audenet F, Traxer O, Yates DR, Cussenot O, Rouprêt M. Potential role of photodynamic techniques combined with new generation flexible ureterorenoscopes and molecular markers for the management of urothelial carcinoma of the upper urinary tract. BJU Int. 2012; 109: 608-13.

9j Traxer O, Geavlete B, de Medina SG, Sibony M, Al-Qahtani SM. Narrowband imaging digital flexible ureteroscopy in detection of upper urinary tract transitional-cell carcinoma: initial experience. J Endourol. 2011; 25: 19-23.

10j Rouprêt M, Babjuk M, Compérat E, et al. European guidelines on upper tract urothelial carcinomas: 2013 update. Eur Urol. 2013; 63: 1059-71.

11j Hendin BN, Streem SB, Levin HS, Klein EA, Novick AC. Impact of diagnostic ureteroscopy on long-term survival in patients with upper tract transitional cell carcinoma. J Urol. 1999; 161: 783-5.


Ⅲ ŠO‰ČŽčp

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3jŽčp—lŽŽŠÖ˜AˆöŽq

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‚ą‚ę‚ç‚Ě1j~3j‚ĚƒŠƒXƒNˆöŽq‚đ‘g‚ݍ‡‚í‚š‚˝Ä”­E“]ˆÚ—Ś‚ ‚邢‚͐ś‘ś—Ś‚Č‚Ç‚Ě—\Œă‚đ—\‘Ş‚ˇ‚éƒmƒ‚ƒOƒ‰ƒ€‚ށC‘ĺ‹K–Í‚ČÇ—áWĎ‚ĚŒă‚ëŒü‚Ť‰đÍ‚É‚ć‚čěŹ‚ł‚ę‚Ä‚˘‚é41jB—\Œă—\‘ރmƒ‚ƒOƒ‰ƒ€‚Í‚ć‚萳Šm‚Č—\Œă„’č‚đ‰Â”\‚Ć‚ľŽĄ—ĂŽwj‚ɏ­‚Č‚Š‚炸‰e‹ż‚đ—^‚Ś‚é‚Ć‚ł‚ę‚é‚ŞC“úí—Տ°‚É‚¨‚Ż‚éŽŔŰ‚Ě—˜—p‰ż’l‚Ě—L—pŤ‚ÍŠm”F‚ł‚ę‚Ä‚˘‚Č‚˘B

ˆČă‚ĚŠłŽŇ”wŒiˆöŽqC•a—‘gDŠw“IˆöŽqCŽčp—lŽŽŠÖ˜AˆöŽq‚Í‚ ‚­‚Ü‚ĹƒŠƒXƒNˆöŽq‚ĚŒó•â‚Ĺ‚ ‚čCŒťŽž“_‚Ĺ’č‚Ü‚Á‚˝Ä”­E“]ˆÚ‚𐜂ś‚é—\Œă•s—ǏǗá‚𐳊m‚É“Ż’股‚郊ƒXƒNˆöŽqC“KŘ‚ČƒŠƒXƒN•Ş—Ţ‚Í‘śÝ‚ľ‚Č‚˘BĄŒăCłŠm‚Č—\Œă•s—ǏǗá‚Ě‘IoCƒŠƒXƒN•Ş—Ţ‚É€‚ś‚˝ŽĄ—Ð헪‚̍\’z‚đ‰Â”\‚Ć‚ˇ‚é‚˝‚߂ɂ́C•ŞŽqƒ}[ƒJ[‚đŠÜ‚ß‚˝‚ł‚ç‚Č‚é—\ŒăˆöŽq’Tő‚Ě“w—Í‚Ş•K—v‚Ĺ‚ ‚éB

Ⅳ t”AŠÇ‘S“EœpEäNă÷•”•ŞŘœpŒă‚ĚäNă÷“ŕÄ”­‚Ě•p“xCŠëŒŻˆöŽq‚Ć‚ť‚Ě—\–h‚ĚŽŽ‚Ý

t”AŠÇ‘S“EœpEäNă÷•”•ŞŘœpŒă‚ĚäNă÷“ŕÄ”­‚́C–ń15~50%‚Ć”äŠr“I‚•p“x‚É”F‚ß‚ç‚ę‚é42jBpŒă‚ĚäNă÷“ŕÄ”­‚đ—\‘Ş‚ˇ‚éˆöŽq‚Ć‚ľ‚āC‘˝”‚ĚŒó•âˆöŽq‚Ş•ń‚ł‚ę‚Ä‚˘‚é‚ŞiCQ10 ŽQĆjCŒťŽž“_‚Ĺ‚ÍŠm—§‚ł‚ę‚˝äNă÷“ŕÄ”­—\‘ވöŽq‚⃊ƒXƒN•Ş—Ţ‚Í‘śÝ‚ľ‚Č‚˘B‹ß”NCt”AŠÇ‘S“EœpEäNă÷•”•ŞŘœpŒă‚̍RŠŕÜ’P‰ń“Š—^‚É‚ć‚éäNă÷“ŕÄ”­—\–hŒř‰Ę‚ĚŒŸ“˘‚Ş•ń‚ł‚ę‚Ä‚˘‚éBƒCƒMƒŠƒX‚Ě‘˝Ž{Ý‹¤“Ż–łěˆ×‰ťŽŽŒą‚ł́C284 —á‚𖳎Ą—ĂŒQ‚ƏpŒăRŠŕÜ’P‰ń“Š—^ŒQ‚Ě‚QŒQ‚É•Ş‚ŻäNă÷“ŕÄ”­—\–hŒř‰Ę‚đŒŸ“˘‚ľ‚Ä‚˘‚é43jB”A“šƒJƒe[ƒeƒ‹”˛‹Ž’ź‘OipŒă–ń‚PTŠÔ–ځj‚Émitomycin C äNă÷“ŕ’“ü—Ă–@‚ŞŽ{s‚ł‚ę‚˝pŒăRŠŕÜ’P‰ń“Š—^ŒQ‚ł́C–łŽĄ—ĂŒQ‚Ć”äŠr‚ľ—LˆÓ‚ÉäNă÷“ŕÄ”­‚Ş—}§‚ł‚ę‚˝B–{–M‚É‚¨‚˘‚Ä‚ŕ‘˝Ž{Ý‹¤“Ż–łěˆ×‰ťŽŽŒą‚É‚ć‚éRŠŕÜ’P‰ń“Š—^ipŒă48 ŽžŠÔˆČ“ŕ‚Épirarubicin äNă÷“ŕ’“ü—Ă–@j‚ĚäNă÷“ŕÄ”­—\–hŒř‰Ę‚ĚŒŸ“˘‚ލs‚í‚ęCpŒăRŠŕÜ’P‰ń“Š—^ŒQ‚Ĺ‚Í–łŽĄ—ĂŒQ‚Ć”äŠr‚ľ—LˆÓ‚ÉäNă÷“ŕÄ”­‚Ş—}§‚ł‚ęCpŒăRŠŕÜ’P‰ń’“üŽĄ—Ă‚ÍäNă÷“ŕÄ”­—}§‚É‹­‚­Šń—^‚ľ‚Ä‚˘‚˝44jB‚ą‚ę‚ç‚Ě•ń‚ć‚čCpŒă‚̍RŠŕÜ’P‰ń’“üŽĄ—Ă‚ÍäNă÷“ŕÄ”­—\–hŒř‰Ę‚Ě–Ę‚Ĺ‚¨‚¨‚˘‚ÉŠú‘Ň‚Ş‚ŕ‚˝‚ę‚é‚ŞC–{ŽĄ—Ă‚ŞŽŔ—Տ°‚Ĺ’č’…‚ˇ‚é‚˝‚ß‚É‚ÍĹ“K‚Č“Š—^–@CˆŔ‘SŤ‚̏\•Ş‚ČŒŸŘ‚Ş‚Č‚ł‚ęC‚ł‚ç‚É‚Í•ŰŒŻ“K—p‚Ě–â‘č‚Č‚Ç‚Ş‰đŒˆ‚ł‚ę‚é•K—v‚Ş‚ ‚éB

Ⅴ t‰ˇ‘śŽčp‚ĚŽčp—lŽŽ‚Ć‚ť‚ĚŽĄ—ÐŹŃ

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t᱋ž‚đ—p‚˘‚˝Œo”ç“IŽĄ—ẤC”AŠÇ‹ž‚ĹƒAƒvƒ[ƒ`‚ލ˘“ď‚ȐtṁCt”t‚ ‚邢‚Íă•””AŠÇŠŕ‚ɑ΂ľ‚Đt‰ˇ‘ś‚đ–Ú“I‚ɍs‚í‚ęC”äŠr“I—ǍD‚ČŽĄ—ÐŹŃ‚Ş•ń‚ł‚ę‚Ä‚˘‚éBRoupret ‚ç‚Í24 —á‚̐t”tŠŕ‚ ‚邢‚͐t᱊ŕ‚ÉŒo”ç“IŽĄ—Ă‚đŽ{s‚ľC62 ƒ•ŒŽ‚ĚŠĎŽ@ŠúŠÔ‚Ĺ‚R—á‚ɋǏŠÄ”­C‚Q—á‚ɉ“Šu“]ˆÚ‚đ”F‚߁C‚T—á‚É‚ť‚ĚŒăt”AŠÇ‘S“EœpEäNă÷•”•ŞŘœp‚đŽ{s‚ľ‚˝‚Ć•ń‚ľ‚Ä‚˘‚é46jBPalou ‚ç‚Í34 —á‚̐táąŠŕ‚ ‚邢‚Íă•””AŠÇŠŕ‚ɑ΂ľ‚ÄŒo”ç“IŽĄ—Ă‚đŽ{s‚ľC51 ƒ•ŒŽ‚ĚŠĎŽ@ŠúŠÔ‚Ĺă•””A˜HÄ”­‚Í41.2%‚É”F‚ß‚ç‚ę‚˝‚ށCŠł‘¤t‰ˇ‘ś—Ś‚Í73.5%‚Ĺ‚ ‚Á‚˝‚Ć•ń‚ľ‚Ä‚˘‚é47jBˆę•űC‹ß”NŠeŽí‚Ě×Œa‚̓”AŠÇ‹ž‚ĚŠJ”­E‰ü—ǂސi‚݁Ct᱋ž‚đ—p‚˘‚˝Œo”ç“IŽĄ—Ă‚Í‚ ‚Ü‚čŽ{s‚ł‚ę‚Č‚˘ŒXŒü‚É‚ ‚éB

‰ş•””AŠÇŠŕ‚ɑ΂ˇ‚é”AŠÇ•”•ŞŘœp‚¨‚ć‚Ń”AŠÇäNă÷V•Ť‡p‚́Ct‰ˇ‘ś‚đ–Ú“I‚Ć‚ľ‚Ä‚ľ‚΂ľ‚ÎŽ{s‚ł‚ę‚éBŽc‘ś”AŠÇ‚ĆäNă÷‚Ü‚Ĺ‚Ě‹——Ł‚Ş’ˇ‚˘ę‡‚ÍBoari flap –@‚âPsoas hitch –@‚Ş—p‚˘‚ç‚ę‚éB‰ş•””AŠÇŠŕ‚ɑ΂ˇ‚é”AŠÇ•”•ŞŘœp‚́CNational Cancer In-stitute‚ĚTransitional Cell Cancer of the Renal Pelvis and Ureter TreatmentiPDQ®j‚É‚¨‚˘‚Ästandard treatment option‚Ć‚Č‚Á‚Ä‚˘‚é48jB“K‰ž‚Í”ńZŤ‚Š‚”AŠÇ‰ş•”‚P/ ‚R‚É‘śÝ‚ˇ‚é’P”­Žîᇂł ‚čCtṁEă•””AŠÇ‚ÉŽîᇂޑśÝ‚ľ‚Ä‚˘‚Č‚˘‚ą‚Ć‚đŠm”F‚ľ‚Ä‚¨‚­•K—v‚Ş‚ ‚éB

ŽQl•śŒŁ

1j Clayman RV, Kavoussi LR, Figenshau RS, Chandhoke PS, Albala DM. Laparoscopic nephroureterectomy: initial clinical case report. J Laparoendosc Surg. 1991; 1: 343-9.

2j Eng MK, Shalhav AL. Laparoscopic nephroureterectomy: long-term outcomes. Curr Opin Urol. 2008; 18: 157-62.

3j Rassweiler JJ, Schulze M, Marrero R, Frede T, Palou Redorta J, Bassi P. Laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma: is it better than open surgery? Eur Urol. 2004; 46: 690-7.

4j Bariol SV, Stewart GD, McNeill SA, Tolley DA. Oncological control following laparoscopic nephroureterectomy: 7-year outcome. J Urol. 2004; 172: 1805-8.

5j Abe T, Harabayashi T, Shinohara N, et al. Outcome of regional lymph node dissection in conjunction with laparoscopic nephroureterectomy for urothelial carcinoma of the upper urinary tract. J Endourol. 2011; 25: 803-7.

6j Rouprêt M, Babjuk M, Compérat E, et al. European guidelines on upper tract urothelial carcinomas: 2013 update. Eur Urol. 2013; 63: 1059-71.

7j Kondo T, Hashimoto Y, Kobayashi H, et al. Template-based lymphadenectomy in urothelial carcinoma of the upper urinary tract: impact on patient survival. Int J Urol. 2010; 17: 848-54.

8j Mcdonald HP, Upchurch WE, Sturdevant CE. Nephro-ureterectomy: a new technique. J Urol. 1952; 67: 804-9.

9j Angulo JC, Hontoria J, Sanchez-Chapado M. One-incision nephroureterectomy endoscopically assisted by transurethral ureteral stripping. Urology. 1998; 52: 203-7.

10j Li WM, Shen JT, Li CC, et al. Oncologic outcomes following three different approaches to the distal ureter and bladder cuff in nephroureterectomy for primary upper urinary tract urothelial carcinoma. Eur Urol. 2010; 57: 963-9.

11j Saika T, Nishiguchi J, Tsushima T, et al. Comparative study of ureteral stripping versus open ureterectomy for nephroureterectomy in patients with transitional carcinoma of the renal pelvis. Urology. 2004; 63: 848-52.

12j Ubrig B, Boenig M, Waldner M, Roth S. Transurethral approach to the distal ureter in nephroureterectomy: transurethral extraction vs. gpluckh technique with long-term follow-up. Eur Urol. 2004; 46: 741-7.

13j Margulis V, Shariat SF, Matin SF, et al. Outcomes of radical nephroureterectomy: a series from the Upper Tract Urothelial Carcinoma Collaboration. Cancer. 2009; 115: 1224-33.

14j Rink M, Sjoberg D, Comploj E, et al. Risk of cancer-specific mortality following recurrence after radical nephroureterectomy. Ann Surg Oncol. 2012; 19: 4337-44.

15j Shariat SF, Godoy G, Lotan Y, et al. Advanced patient age is associated with inferior cancer-specific survival after radical nephroureterectomy. BJU Int. 2010; 105: 1672-7.

16j Fernández MI, Shariat SF, Margulis V, et al. Evidence-based sex-related outcomes after radical nephroureterectomy for upper tract urothelial carcinoma: results of large multicenter study. Urology. 2009; 73: 142-6.

17j Lughezzani G, Sun M, Perrotte P, et al. Gender-related differences in patients with stage I to III upper tract urothelial carcinoma: results from the Surveillance, Epidemiology, and End Results database. Urology. 2010; 75: 321-7.

18j Raman JD, Shariat SF, Karakiewicz PI, et al. Does preoperative symptom classification impact prognosis in patients with clinically localized upper-tract urothelial carcinoma managed by radical nephroureterectomy? Urol Oncol. 2011; 29: 716-23.

19j Rink M, Xylinas E, Margulis V, et al. Impact of smoking on oncologic outcomes of upper tract urothelial carcinoma after radical nephroureterectomy. Eur Urol. 2013; 63: 1082-90.

20j Ouzzane A, Colin P, Xylinas E, et al. Ureteral and multifocal tumours have worse prognosis than renal pelvic tumours in urothelial carcinoma of the upper urinary tract treated by nephroureterectomy. Eur Urol. 2011; 60: 1258-65.

21j Raman JD, Ng CK, Scherr DS, et al. Impact of tumor location on prognosis for patients with upper tract urothelial carcinoma managed by radical nephroureterectomy. Eur Urol. 2010; 57: 1072-9.

22j Ito Y, Kikuchi E, Tanaka N, et al. Preoperative hydronephrosis grade independently predicts worse pathological outcomes in patients undergoing nephroureterectomy for upper tract urothelial carcinoma. J Urol. 2011; 185: 1621-6.

23j Brown GA, Matin SF, Busby JE, et al. Ability of clinical grade to predict final pathologic stage in upper urinary tract transitional cell carcinoma: implications for therapy. Urology. 2007; 70: 252-6.

24j Ng CK, Shariat SF, Lucas SM, et al. Does the presence of hydronephrosis on preoperative axial CT imaging predict worse outcomes for patients undergoing nephroureterectomy for upper-tract urothelial carcinoma? Urol Oncol. 2011; 29: 27-32.

25j Li CC, Chang TH, Wu WJ, et al. Significant predictive factors for prognosis of primary upper urinary tract cancer after radical nephroureterectomy in Taiwanese patients. Eur Urol. 2008; 54: 1127-34.

26j Novara G, De Marco V, Gottardo F, et al. Independent predictors of cancerspecific survival in transitional cell carcinoma of the upper urinary tract: multi-institutional dataset from 3 European centers. Cancer. 2007; 110: 1715-22.

27j Lughezzani G, Jeldres C, Isbarn H, et al. Nephroureterectomy and segmental ureterectomy in the treatment of invasive upper tract urothelial carcinoma: a population-based study of 2299 patients. Eur J Cancer. 2009; 45: 3291-7.

28j Bolenz C, Shariat SF, Fernández MI, et al. Risk stratification of patients with nodal involvement in upper tract urothelial carcinoma: value of lymph-node density. BJU Int. 2009; 103: 302-6.

29j Wheat JC, Weizer AZ, Wolf JS Jr., et al. Concomitant carcinoma in situ is a feature of aggressive disease in patients with organ confined urothelial carcinoma following radical nephroureterectomy. Urol Oncol. 2012; 30: 252-8.

30j Kikuchi E, Margulis V, Karakiewicz PI, et al. Lymphovascular invasion predicts clinical outcomes in patients with node-negative upper tract urothelial carcinoma. J Clin Oncol. 2009; 27: 612-8.

31j Novara G, Matsumoto K, Kassouf W, et al. Prognostic role of lymphovascular invasion in patients with urothelial carcinoma of the upper urinary tract: an international validation study. Eur Urol. 2010; 57: 1064-71.

32j Chromecki TF, Cha EK, Fajkovic H, et al. The impact of tumor multifocality on outcomes in patients treated with radical nephroureterectomy. Eur Urol. 2012; 61: 245-53.

33j Simone G, Papalia R, Loreto A, Leonardo C, Sentinelli S, Gallucci M. Independent prognostic value of tumour diameter and tumour necrosis in upper urinary tract urothelial carcinoma. BJU Int. 2009; 103: 1052-7.

34j Shariat SF, Zigeuner R, Rink M, et al. Subclassification of pT3 urothelial carcinoma of the renal pelvicalyceal system is associated with recurrence-free and cancer-specific survival: proposal for a revision of the current TNM classification. Eur Urol. 2012; 62: 224-31.

35j Yoshimura K, Arai Y, Fujimoto H, et al. Prognostic impact of extensive parenchymal invasion pattern in pT3 renal pelvic transitional cell carcinoma. Cancer. 2002; 94: 3150-6.

36j Capitanio U, Shariat SF, Isbarn H, et al. Comparison of oncologic outcomes for open and laparoscopic nephroureterectomy: a multi-institutional analysis of 1249 cases. Eur Urol. 2009; 56: 1-9.

37j Simone G, Papalia R, Guaglianone S, et al. Laparoscopic versus open nephroureterectomy: perioperative and oncologic outcomes from a randomised prospective study. Eur Urol. 2009; 56: 520-6.

38j Xylinas E, Rink M, Cha EK, et al. Impact of distal ureter management on oncologic outcomes following radical nephroureterectomy for upper tract urothelial carcinoma. Eur Urol. 2014; 65: 210-7.

39j Kondo T, Nakazawa H, Ito F, Hashimoto Y, Toma H, Tanabe K. Impact of the extent of regional lymphadenectomy on the survival of patients with urothelial carcinoma of the upper urinary tract. J Urol. 2007; 178: 1212-7.

40j Roscigno M, Shariat SF, Margulis V, et al. Impact of lymph node dissection on cancer specific survival in patients with upper tract urothelial carcinoma treated with radical nephroureterectomy. J Urol. 2009; 181: 2482-9.

41j Cha EK, Shariat SF, Kormaksson M, et al. Predicting clinical outcomes after radical nephroureterectomy for upper tract urothelial carcinoma. Eur Urol. 2012; 61: 818-25.

42j Azémar MD, Comperat E, Richard F, Cussenot O, Rouprêt M. Bladder recurrence after surgery for upper urinary tract urothelial cell carcinoma: fre-quency, risk factors, and surveillance. Urol Oncol. 2011; 29: 130-6.

43j OfBrien T, Ray E, Singh R, Coker B, Beard R; British Association of Urological Surgeons Section of Oncology. Prevention of bladder tumours after nephroureterectomy for primary upper urinary tract urothelial carcinoma: a prospective, multicentre, randomised clinical trial of a single postoperative intravesical dose of mitomycin C ithe ODMIT-C Trialj. Eur Urol. 2011; 60: 703-10.

44j Ito A, Shintaku I, Satoh M, et al. Prospective randomized phase II trial of a single early intravesical instillation of pirarubicin iTHPj in the prevention of bladder recurrence after nephroureterectomy for upper urinary tract urothelial carcinoma: the THP Monotherapy Study Group Trial. J Clin Oncol. 2013; 31: 1422-7.

45j Cutress ML, Stewart GD, Zakikhani P, Phipps S, Thomas BG, Tolley DA. Ureteroscopic and percutaneous management of upper tract urothelial carcinomaiUTUCj: systematic review. BJU Int. 2012; 110: 614-28.

46j Roupret M, Traxer O, Tligui M, et al. Upper urinary tract transitional cell carcinoma: recurrence rate after percutaneous endoscopic resection. Eur Urol. 2007; 51: 709-13.

47j Palou J, Piovesan LF, Huguet J, Salvador J, Vicente J, Villavicencio H. Percutaneous nephroscopic management of upper urinary tract transitional cell carcinoma: recurrence and long-term followup. J Urol. 2004; 172: 66-9.

48j


CQ5
 
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Answer

tṁE”AŠÇŠŕ‚É‚¨‚Ż‚é• o‹žŽčp‚ÍŠJ•úŽčp‚Ć”äŠr‚ľ‚Ä’áNP‚Ĺ‚ ‚čC•aŠúT2 ‚Ü‚Ĺ‚ĚÇ—á‚ł͐§ŠŕŒř‰Ę‚É‚ŕˇ‚đ”F‚ß‚¸C\•Ş‚Č• o‹žŽčp‚Ě‹Zp‚đ—L‚ˇ‚éę‡‚͐„§‚ł‚ę‚épŽŽ‚Ĺ‚ ‚éi„§ƒOƒŒ[ƒhBjB

‰đ ŕ

t”AŠÇ‘S“Eœp‚É‚¨‚Ż‚éŽčpŽžŠÔ‚Í• o‹žŽčp‚ŞŠJ•úŽčp‚ć‚č‚ŕ’ˇ‚˘1j2j‚ ‚邢‚Í“Ż“™‚Ć‚˘‚¤•ń‚Ş‘˝‚˘‚Ş3j4jCă• •”•Â‘n‚É—v‚ˇ‚鎞ŠÔ‚Ş‚Č‚˘‚˝‚ß‹t‚É• o‹žŽčp‚Ş’Z‚˘‚Ć‚Ě•ń‚ŕ‚ ‚é5j6jBƒŠƒ“ƒpßŠs´‚É—v‚ˇ‚鎞ŠÔ‚â‘ĚˆĘ•ĎŠˇ‚É—v‚ˇ‚鎞ŠÔ‚Č‚Ç‚ĚÚ×‚Č‹LÚ‚Ě‚ ‚é•ń‚͏­‚Č‚˘‚ށCŠT‚ËŽčpŽžŠÔ‚ɂ‚˘‚Ä‚Í• o‹žŽčp‚ŞŠJ•úŽčp‚ć‚č’ˇ‚˘‚Š‚Ü‚˝‚Í“Ż“™‚ƍl‚Ś‚ç‚ę‚éB‚Ü‚˝p’†oŒŒ—Ę‚Í• o‹žŽčp‚ŞŠJ•úŽčp‚ć‚č—LˆÓ‚ɏ­‚Č‚˘‚Ć‚˘‚¤•ń‚Ş‘˝‚˘‚ށC—źŽŇŠÔ‚ɍˇ‚đ”F‚ß‚Č‚˘‚Ć‚Ě•ń‚ŕ‚ ‚é7jB2009 ”N‚É•ń‚ł‚ę‚˝• o‹žŽčpi—pŽč•â•‚đŠÜ‚ށj‚ĆŠJ•úŽčp‚đ”äŠr‚ľ‚˝–łěˆ×‰ť”äŠrŽŽŒą‚ł́C• o‹žŽčp‚Ĺ—LˆÓ‚ɏoŒŒ—Ę‚Ş­‚Č‚˘i104 ml vs 430 mlj‚Ć•ń‚ł‚ę‚Ä‚˘‚é8jB

pŒăáu’ɂƉń•œŠúŠÔ‚ɂ‚˘‚ẮC• o‹žŽčp‚ŞŠJ•úŽčp‚Ć”äŠr‚ľ‚Ä•ŕsŠJŽnŽžŠúCHŽ–ŠJŽnŽžŠúC’Á’É–ňŽg—p—ʁC“ü‰@ŠúŠÔCŽĐ‰ď•œ‹A‚Ü‚Ĺ‚ĚŠúŠÔ‚Ě‚˘‚¸‚ę‚É‚¨‚˘‚Ä‚ŕ—LˆÓ‚É—D‚ę‚Ä‚¨‚čC• o‹žŽčp‚̏pŒă‰ń•œ‚ÍŠJ•úŽčp‚ć‚č‚ŕ‘‚˘‚ƍl‚Ś‚ç‚ę‚é5j9j10jB

‚ą‚ę‚Ü‚Ĺ‚É• o‹žŽčpi—pŽč•â•‚đŠÜ‚ށj‚ĆŠJ•úŽčp‚đ”äŠr‚ľ‚˝˜_•ś‚ސ”‘˝‚­‘śÝ‚ˇ‚é‚ŞC2006 ”NˆČ~‚É”­•\‚ł‚ę‚˝•ń7j11j|14j‚É‚ć‚é‚ƁC‹ÇŠÄ”­—Ś‚âäNă÷“ŕÄ”­—Ś‚ ‚邢‚͐ś‘ś—Ś‚ɍˇ‚đ”F‚ß‚Č‚˘‚Ć‚ˇ‚é‚ŕ‚Ě‚Ş‚Ů‚Ć‚ń‚Ç‚Ĺ‚ ‚éBćq‚ľ‚˝2009 ”N‚Ě–łěˆ×‰ť”äŠrŽŽŒą‚ł́CŹ‹K–Í‚Ě’PˆęŽ{Ý‚É‚¨‚Ż‚錟“˘‚Ĺ‚Í‚ ‚é‚ŞpT3Chigh grade ‚ĚÇ—á‚Ĺ‚ÍŠJ•úŽčp‚Ě‚Ů‚¤‚ޏpŒă‚R”N‚ĚŠŕ“ÁˆŮ“Iś‘ś—Ś‚ލ‚‚­C–łÄ”­ś‘śŠúŠÔ‚Ş—LˆÓ‚ɉ„’ˇ‚ľ‚Ä‚˘‚é‚Ć•ń‚ł‚ę‚Ä‚˘‚é8jB‘ź‚Ě•ń‚Ĺ‚ŕ• o‹žŽčp‚ĹŽĄ—Ă‚ľ‚˝high grade Ç—á‚Ĺ‚Í—LˆÓ‚É‘Sś‘ś—ŚCŠŕ“ÁˆŮ“Iś‘ś—Ś‚Ş’á‚Š‚Á‚˝‚Ć‚ł‚ę‚Ä‚˘‚é9jB‚ą‚Ě——R‚Ěˆęˆö‚Ć‚ľ‚Ähigh gradeChigh stage ‚ĚÇ—á‚Ĺ‚ÍƒŠƒ“ƒpß“]ˆÚ‚𑁊ú‚É‚Ť‚˝‚ľ‚Ä‚˘‚éÇ—á‚Ş‘˝‚­C‚ć‚Á‚ăŠƒ“ƒpßŠs´‚ĚŽ{s‚ސ„§‚ł‚ę‚Ä‚˘‚é‚Ş15jC• o‹žŽčp‚Ĺ‚ÍŠJ•úŽčp‚Ć“Ż—l‚ĚƒŠƒ“ƒpßŠs´‚đs‚¤‚É‚ÍŒŔŠE‚Ş‚ ‚é‚˝‚ß‚Ćl‚Ś‚ç‚ę‚éB”ńŒŔ‹ÇŤtṁE”AŠÇŠŕ‚ɑ΂ˇ‚é• o‹žŽčp‚̐§ŠŕŒř‰Ę‚ÉŠÖ‚ľ‚Ă͏\•Ş‚ČŒŸŘ‚Ş‚Č‚ł‚ę‚Ä‚˘‚Č‚˘‚Ě‚ŞŒťó‚Ĺ‚ ‚čCĹI“I‚ČŒ‹˜_‚đo‚ˇ‚˝‚ß‚É‚Í‚ł‚ç‚Č‚é‘ĺ‹K–Í‚Č–łěˆ×‰ť”äŠrŽŽŒą‚Ş•K—v‚Ĺ‚ ‚éB

‹H‚Ĺ‚Í‚ ‚é‚Ş• o‹žŽčp‚̍‡•šÇ‚Ě‚Đ‚Ć‚Â‚Éƒ|[ƒgÄ”­‚Ş‚ ‚čC2004 ”N‚ĚƒŒƒrƒ…[‚É‚ć‚é‚Ć•p“x‚Í1.2~1.6%‚Ć‚ł‚ę1jC2008 ”N‚Ü‚Ĺ‚É•śŒŁă11 —á•ń‚ł‚ę‚Ä‚˘‚é16jB•W–{‚Í‘Ü‚É“ü‚ę‚ĉńŽű‚ˇ‚é‚ą‚Ć‚Ş‘E‚ß‚ç‚ę‚Ä‚˘‚é17jB

ŽQl•śŒŁ

1j Rassweiler JJ, Schulze M, Marrero R, Frede T, Palou Redorta J, Bassi P. Laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma: is it better than open surgery? Eur Urol. 2004; 46: 690-7.

2j Hsueh TY, Huang YH, Chiu AW, Shen KH, Lee YH. A comparison of the clinical outcome between open and hand-assisted laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma. BJU Int. 2004; 94: 798-801.

3j McNeill SA, Chrisofos M, Tolley DA. The long-term outcome after laparoscopic nephroureterectomy: a comparison with open nephroureterectomy. BJU Int. 2000; 86: 619-23.

4j Kawauchi A, Fujito A, Ukimura O, Yoneda K, Mizutani Y, Miki T. Hand assisted retroperitoneoscopic nephroureterectomy: comparison with the open procedure. J Urol. 2003; 169: 890-4.

5j Gill IS, Sung GT, Hobart MG, et al. Laparoscopic radical nephroureterectomy for upper tract transitional cell carcinoma: the Cleveland Clinic experience. J Urol. 2000; 164: 1513-22.

6j ”É“cłMCŠpź—YˆęCˆŔ–{”ŽWCŽO“ckŽiC‰Oˆä˜ąDă•””A˜Hă”çŽîᇂɑ΂ˇ‚éŒă• –Œ‹ž•â•‰şt”AŠÇ‘S“Eœp‚ĚŒŸ“˘. Jpn J Endourol and ESWL. 2004; 17: 190-4.

7j Greco F, Wagner S, Hoda RM, Hamza A, Fornara P. Laparoscopic vs open radical nephroureterectomy for upper urinary tract urothelial cancer: oncological outcomes and 5-year follow-up. BJU Int. 2009; 104: 1274-8.

8j Simone G, Papalia R, Guaglianone S, et al. Laparoscopic versus open nephroureterectomy: perioperative and oncologic outcomes from a randomised prospective study. Eur Urol. 2009; 56: 520-6.

9j Terakawa T, Miyake H, Hara I, Takenaka A, Fujisawa M. Retroperitoneoscopic nephroureterectomy for upper urinary tract cancer: a comparative study with conventional open retroperitoneal nephroureterectomy. J Endourol. 2008; 22: 1693-9.

10j Rai BP, Shelley M, Coles B, Biyani CS, El-Mokadem I, Nabi G. Surgical management for upper urinary tract transitional cell carcinoma. Cochrane Database Syst Rev. 2011: CD007349.

11j Waldert M, Remzi M, Klingler HC, Mueller L, Marberger M. The oncological results of laparoscopic nephroureterectomy for upper urinary tract transitional cell cancer are equal to those of open nephroureterectomy. BJU Int. 2009; 103: 66-70.

12j Capitanio U, Shariat SF, Isbarn H, et al. Comparison of oncologic outcomes for open and laparoscopic nephroureterectomy: a multi-institutional analysis of 1249 cases. Eur Urol. 2009; 56: 1-9.

13j Favaretto RL, Shariat SF, Chade DC, et al. Comparison between laparoscopic and open radical nephroureterectomy in a contemporary group of patients: are recurrence and disease-specific survival associated with surgical technique? Eur Urol. 2010; 58: 645-51.

14j Hattori R, Yoshino Y, Gotoh M, Katoh M, Kamihira O, Ono Y. Laparoscopic nephroureterectomy for transitional cell carcinoma of renal pelvis and ureter: Nagoya experience. Urology. 2006; 67: 701-5.

15j Kondo T, Nakazawa H, Ito F, Hashimoto Y, Toma H, Tanabe K. Impact of the extent of regional lymphadenectomy on the survival of patients with urothelial carcinoma of the upper urinary tract. J Urol. 2007; 178: 1212-7.

16j Zigeuner R, Pummer K. Urothelial carcinoma of the upper urinary tract: surgical approach and prognostic factors. Eur Urol. 2008; 53: 720-31.

17j Schatteman P, Chatzopoulos C, Assenmacher C, et al. Laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma: results of a Belgian retrospective multicentre survey. Eur Urol. 2007; 51: 1633-8.


CQ6
t”AŠÇ‘S“EœpEäNă÷•”•ŞŘœp‚É‚¨‚˘‚ăŠƒ“ƒpßŠs´‚͐„§‚ł‚ę‚é‚Š?

Answer

ƒŠƒ“ƒpßŠs´‚ĚˆÓ‹`‚́Cf’f“IˆÓ‹`‚ĆŽĄ—Ă“IˆÓ‹`‚É•Ş‚Š‚ę‚éBŠs´‚É‚ć‚č•a—Šw“IƒŠƒ“ƒpß“]ˆÚ—zŤ‚Ě—\Œă•s—Ç‚ĚŠłŽŇ‚đ‘w•Ę‰ť‚Ĺ‚Ťf’f“IˆÓ‹`‚Í‚ ‚é‚ƍl‚Ś‚ç‚ę‚éB‚Ü‚˝pT2 ˆČă‚ĚÇ—á‚ł́CŠs´‚É‚ć‚č—\Œă‚đ‰ü‘P‚ˇ‚é‚ĆŽĄ—Ă“IˆÓ‹`‚đŽxŽ‚ˇ‚é•ń‚Í‘˝‚˘B]‚Á‚Ä‹Ř‘wZ‚Ş‹^‚í‚ę‚éisŠŕÇ—á‚ɑ΂ľ‚ăŠƒ“ƒpßŠs´‚đŽ{s‚ˇ‚é‚ą‚Ƃ͐„§‚ł‚ę‚éi„§ƒOƒŒ[ƒhC1jB

‰đ ŕ

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tṁE”AŠÇŠŕ‚É‚¨‚˘‚Ä‚ŕŠs´”͈͕͂W€‰ť‚ł‚ę‚Ä‚˘‚Č‚˘BKondo ‚ç‚Ěmapping study ‚É‚ć‚ę‚΁C‰Et᱊ŕE‰Eă’†•””AŠÇŠŕ‚É‚¨‚˘‚Ä‚Í‘ĺ“Ž–Ź‚ć‚芳‘¤‚̍L‚˘”͈͂ށCśt᱊ŕEśă’†•””AŠÇŠŕ‚Ĺ‚Íśt–ĺ•”C–T‘ĺ“Ž–ŹC‰ş•””AŠÇŠŕ‚Ĺ‚ÍŠł‘¤‚ĚŠO’°œC“ŕ’°œC•Â˝C‘’°œ—Ěˆć‚ŞˆęŽŸ“]ˆÚƒŠƒ“ƒpßC‚ˇ‚Č‚í‚żŠ‘ŽƒŠƒ“ƒpß‚Ĺ‚ ‚é‚Ć•ń‚ł‚ę‚Ä‚˘‚é4jB‚ľ‚Š‚ľC‚ą‚ĚƒŠƒ“ƒpßmapping‚Ě‘Ă“–Ť‚đŒŸŘ‚ľ‚˝•ń‚Í–˘‚ž‚Ý‚ç‚ę‚Ä‚˘‚Č‚˘B

ƒŠƒ“ƒpßŠs´‚Ě—Ő°“IˆÓ‹`‚̂ЂƂ‚͐f’f“IˆÓ‹`C‚ˇ‚Č‚í‚ż‚ť‚ĚŒă‚Ě•â•—Ă–@‚Ě“K‰ž‚đŒˆ’č‚ˇ‚é‚Č‚ÇŠłŽŇ‚Ě—\Œă‚Ě‘w•Ę‰ť‚É—L—p‚Ĺ‚ ‚é‚Š‚Ç‚¤‚Š‚Ĺ‚ ‚éB”‰Ć‚Ě•ń‚ÍpNxi”ńŠs´ŒQj‚Ě—\Œă‚É”ä‚×pN0 ŒQiŠs´‚É‚ć‚čƒŠƒ“ƒpß“]ˆÚ‚Ş”F‚ß‚ç‚ę‚Č‚˘ŒQj‚Ě—\Œă‚Ş—D‚ę‚Ä‚˘‚é‚ą‚ƁC‚Ü‚˝pN+ ŒQi•a—Šw“IƒŠƒ“ƒpß“]ˆÚ—zŤŒQj‚Ě—\Œă‚ވŤ‚˘‚ą‚Ć‚đŽŚ‚ľC‚ť‚̐f’f“IˆÓ‹`‚đŽxŽ‚ľ‚Ä‚˘‚é5j|11jB

ŽĄ—Ă“IˆÓ‹`‚ɂ‚˘‚ẮCˆÓŒŠ‚Ş•Ş‚Š‚ę‚Ä‚˘‚éB‚R‚‚̒PˆęŽ{Ý‚ĚŒă‚ëŒü‚ŤŒ¤‹†‚ł́CpT2 ‚ ‚邢‚ÍpT3 ˆČă‚Ě‹ÇŠZŤŠŕ‚É‚¨‚˘‚ăŠƒ“ƒpßŠs´‚É‚ć‚č—\Œă‚މü‘P‚ľ‚˝‚ą‚Ć‚ŞŠm”F‚ł‚ę‚Ä‚˘‚é5j12j13jB13 Ž{Ý‚Ě1,453 —á‚đ‚Ü‚Ć‚ß‚˝ƒf[ƒ^‚ł́CŠs´ŒQ‚Ć”ńŠs´ŒQ‚̐ś‘ś—Ś‚Ĺ‚Íˇ‚Ş‚Č‚Š‚Á‚˝BpN0 ‚ĚÇ—á‚Ě‚Ý‚ÉŒŔ‚Á‚ÄŒŸ“˘‚ˇ‚é‚ƁC“EoƒŠƒ“ƒpß”‚Ş‚WŒÂ–˘–ž‚ĚÇ—á‚É”ä‚ׂWŒÂˆČă‚ĚŒQ‚Ĺ—LˆÓ‚É—\Œă‚މü‘P‚ľ‚Ä‚˘‚é‚ą‚Ć‚Š‚çCŠs´”͈͂ޗ\Œă‚ɉe‹ż‚đ—^‚Ś‚é‚ą‚Ć‚ŞŽŚ‚ł‚ę‚Ä‚˘‚é14jB‚˝‚ž‚ľ‚ą‚ĚŒŸ“˘‚ÉŠÖ‚ľ‚ẮCŠs´”͈͂đŠg‘ĺ‚ľ‚˝‚ą‚Ć‚É‚ć‚čC‚ť‚ę‚Ü‚Ĺ”­ŒŠ‚ł‚ę‚Ä‚˘‚Č‚Š‚Á‚˝pN+ Ç—á‚Ş‚ć‚č‘˝‚­pN0 Ç—á‚ć‚čœŠO‚ł‚ę‚˝Œ‹‰ĘCpN0 ‚Ě—\Œă‚މü‘P‚ľ‚Ä‚˘‚é‚悤‚ÉŒŠ‚Š‚Żă‚Ý‚ç‚ę‚é‚ž‚Ż‚ɉ߂Ź‚Č‚˘iWill-Rogers ŒťŰj‚Ƃ̔ᔝ‚ŕ‘śÝ‚ˇ‚é15jB293 —á‚Ě‘˝Ž{Ý‹¤“ŻŒ¤‹†‚Ĺ‚ŕCƒŠƒ“ƒpß”ńŠs´ipNxj‚Ş‘˝•Ď—ʉđÍ‚Ĺ“Ć—§‚ľ‚˝—LˆÓ‚Č—\Œă•s—LjöŽq‚Ĺ‚ ‚čCŠs´‚É‚ć‚é—\Œă‰ü‘PŒř‰Ę‚̉”\Ť‚đ•ń‚ľ‚Ä‚˘‚é7j14jB785 —á‚Ě‘˝Ž{Ý‹¤“ŻŒ¤‹†‚ŕC‹ÇŠZŤŠŕ‚ɑ΂ˇ‚郊ƒ“ƒpßŠs´‚É‚¨‚˘‚ÄpN0 ‚Ĺ‚ ‚ę‚΁CpNx ‚É”ä‚׍Ĕ­CŠŕŽ€‚ĚƒŠƒXƒN‚đŒ¸­‚ł‚š‚é‚Ć•ń‚ľ‚Ä‚˘‚é9jBˆę•űC2,824 —á‚đŒŸ“˘‚ľ‚˝population-based study 8j‚ł́CpN0 ‚ĆpNx ‚ĚŠŕ“ÁˆŮ“Iś‘ś—Ś‚ɍˇ‚Ş‚Č‚˘‚ą‚Ć‚Š‚玥—Ă“IˆÓ‹`‚Í‚Č‚˘‚Ć•ń‚ľ‚Ä‚˘‚éBƒtƒ‰ƒ“ƒX11j‚¨‚ć‚ŃƒJƒiƒ_10j‚Ě‘˝Ž{Ý‹¤“ŻŒ¤‹†‚Ĺ‚ŕC“Ż—l‚ɃŠƒ“ƒpßŠs´‚ĚŽĄ—Ă“IˆÓ‹`‚đ‹^–⎋‚ľ‚Ä‚˘‚éB‚ą‚ę‚ç‚Ě•ńŒ‹‰Ę‚Ě‘Šˆá‚́CŠs´”ÍˆÍ‚Ěˆá‚˘‚Ş‘ĺ‚Ť‚­‰e‹ż‚ľ‚Ä‚˘‚é‚ĆŽv‚í‚ę‚éBKondo ‚ç‚́C‰đ–UŠw“Iƒeƒ“ƒvƒŒ[ƒg‚É‚ľ‚˝‚Ş‚Á‚˝ŠŽ‘SŠs´‚É‚ć‚č—LˆÓ‚ČŽĄ—Ă“IŒř‰Ę‚đ”F‚ß‚˝‚Ć•ń‚ľ‚Ä‚¨‚č16jC‰đ–UŠw“Iƒeƒ“ƒvƒŒ[ƒg‚ɉˆ‚Á‚˝Šs´‚̏d—vŤ‚đŽw“E‚ľ‚Ä‚˘‚éB

ŒťŽž“_‚Ĺ‚ÍŒ¤‹†‚̐”‚ŕ­‚Č‚­CŠs´”ÍˆÍ‚Ě•W€‰ť‚Ş‚Č‚ł‚ę‚Ä‚˘‚Č‚˘‚ą‚ƁC–łěˆ×‰ťŽŽŒą‚É‚ć‚é—DˆĘŤ‚ŞŽŚ‚ł‚ę‚Ä‚˘‚Č‚˘‚ą‚Ć‚Š‚çCƒŠƒ“ƒpßŠs´‚đŽxŽ‚ˇ‚éƒGƒrƒfƒ“ƒX‚͎ア‚ĆŒž‚í‚´‚é‚đ“ž‚Č‚˘B‚ą‚Ě‚˝‚߁C2013 ”NEAU ƒKƒCƒhƒ‰ƒCƒ“‚ł͐isŠŕ‚É‚¨‚˘‚Ä‚Ě‚Ý‚ť‚ĚˆÓ‹`‚Ş‚ ‚é‚Ć‚ľC„§ƒOƒŒ[ƒhC‚Ć‚ľ‚Ä‚˘‚é17jB‹Ř‘wZŤtṁE”AŠÇŠŕ‚É‚¨‚Ż‚郊ƒ“ƒpßŠs´‚ĚŽĄ—Ă“IˆÓ‹`‚ĚŠm—§‚ÉŒü‚ŻCĄŒă‚ł‚ç‚Č‚éŒŸ“˘Œ‹‰Ę‚ŞŠú‘Ň‚ł‚ę‚éB

ŽQl•śŒŁ

1j Dhar NB, Klein EA, Reuther AM, Thalmann GN, Madersbacher S, Studer UE. Outcome after radical cystectomy with limited or extended pelvic lymph node dissection. J Urol. 2008; 179: 873-8.

2j Abol-Enein H, Tilki D, Mosbah A, et al. Does the extent of lymphadenectomy in radical cystectomy for bladder cancer influence disease-free survival? A prospective single-center study. Eur Urol. 2011; 60: 572-7.

3j Stenzl A, Cowan NC, De Santis M, et al. Treatment of muscle-invasive and metastatic bladder cancer: update of the EAU guidelines. Eur Urol. 2011; 59: 1009-18.

4j Kondo T, Nakazawa H, Ito F, Hashimoto Y, Toma H, Tanabe K. Primary site and incidence of lymph node metastases in urothelial carcinoma of upper urinary tract. Urology. 2007; 69: 265-9.

5j Roscigno M, Cozzarini C, Bertini R, et al. Prognostic value of lymph node dissection in patients with muscle-invasive transitional cell carcinoma of the upper urinary tract. Eur Urol. 2008; 53: 794-802.

6j Roscigno M, Shariat SF, Margulis V, et al. Impact of lymph node dissection on cancer specific survival in patients with upper tract urothelial carcinoma treated with radical nephroureterectomy. J Urol. 2009; 181: 2482-9.

7j Abe T, Shinohara N, Muranaka M, et al. Role of lymph node dissection in the treatment of urothelial carcinoma of the upper urinary tract: multi-institutional relapse analysis and immunohistochemical re-evaluation of negative lymph nodes. Eur J Surg Oncol. 2010; 36: 1085-91.

8j Lughezzani G, Jeldres C, Isbarn H, et al. A critical appraisal of the value of lymph node dissection at nephroureterectomy for upper tract urothelial carcinoma. Urology. 2010; 75: 118-24.

9j Burger M, Shariat SF, Fritsche HM, et al. No overt influence of lymphadenectomy on cancer-specific survival in organ-confined versus locally advanced upper urinary tract urothelial carcinoma undergoing radical nephroureterectomy: a retrospective international, multi-institutional study. World J Urol. 2011; 29: 465-72.

10j Mason RJ, Kassouf W, Bell DG, et al. The contemporary role of lymph node dissection during nephroureterectomy in the management of upper urinary tract urothelial carcinoma: the Canadian experience. Urology. 2012; 79: 840-5.

11j Ouzzane A, Colin P, Ghoneim TP, et al. The impact of lymph node status and features on oncological outcomes in urothelial carcinoma of the upper urinary tract iUTUCj treated by nephroureterectomy. World J Urol. 2013; 31: 189-97.

12j Brausi MA, Gavioli M, De Luca G, et al. Retroperitoneal lymph node dissectioniRPLDj in conjunction with nephroureterectomy in the treatment of infiltrative transitional cell carcinoma iTCCj of the upper urinary tract: impact on survival. Eur Urol. 2007; 52: 1414-8.

13j Kondo T, Nakazawa H, Ito F, Hashimoto Y, Toma H, Tanabe K. Impact of the extent of regional lymphadenectomy on the survival of patients with urothelial carcinoma of the upper urinary tract. J Urol. 2007; 178: 1212-7.

14j Roscigno M, Shariat SF, Margulis V, et al. The extent of lymphadenectomy seems to be associated with better survival in patients with nonmetastatic upper-tract urothelial carcinoma: how many lymph nodes should be removed? Eur Urol. 2009; 56: 512-8.

15j Feinstein AR, Sosin DM, Wells CK. The Will Rogers phenomenon. Stage migration and new diagnostic techniques as a source of misleading statistics for survival in cancer. N Engl J Med. 1985; 312: 1604-8.

16j Kondo T, Hashimoto Y, Kobayashi H, et al. Template-based lymphadenectomy in urothelial carcinoma of the upper urinary tract: Impact on patient survival. Int J Urol. 2010; 17: 848-54.

17j Rouprêt M, Babjuk M, Compérat E, et al. European guidelines on upper tract urothelial carcinomas: 2013 update. Eur Urol. 2013; 63: 1059-71.


CQ7
t”AŠÇ‘S“EœpEäNă÷•”•ŞŘœp‚ĚäNă÷•”•ŞŘœpŽŽ‚ɂ͂ǂ̂悤‚Č‚ŕ‚Ě‚Ş‚ ‚é‚Š?

Answer

äNă÷ŠOƒAƒvƒ[ƒ`CäNă÷“ŕƒAƒvƒ[ƒ`‚¨‚ć‚Ń“ŕŽ‹‹ž“IƒAƒvƒ[ƒ`‚É•Ş—Ţ‚ł‚ę‚é‚ŞC‚ť‚ę‚ź‚ę‚ÉŠeŽípŽŽ‚Ş‘śÝ‚ˇ‚éBŒťŽž“_‚ł́C‹ÇŠÄ”­EŽîᇔdŽí‚̉”\Ť‚âCŠłŽŇ‚É—^‚Ś‚éNPŤCpŽŇ‚ĚŒoŒą’l“™‚đ‘‡“I‚É”ť’f‚ľ‚āCŒÂX‚ĚÇ—á‚˛‚Ć‚ÉäNă÷•”•ŞŘœpŽŽ‚đŒŸ“˘‚ˇ‚é‚ą‚Ć‚Ş–]‚Ü‚ę‚éi„§ƒOƒŒ[ƒhC1jB

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t”AŠÇ‘S“Eœp‚ł́CäNă÷•Ç“ŕ”AŠÇ‚đŠÜ‚މ“ˆĘ”AŠÇ‚đŽüˆÍäNă÷•Ç‚Ć‚Ć‚ŕ‚ɐ؏œ‚ˇ‚é‚ą‚Ć‚Ş‹‚ß‚ç‚ę‚é‚ŞC‚ť‚Ě•ű–@‚É‚Í—lX‚ȏpŽŽ‚Ş‘śÝ‚ˇ‚éB

äNă÷ŠOƒAƒvƒ[ƒ`‚́C”AŠÇŒűŽü•Ó‚ĚäNă÷•Ç‚đŠJ•ú‚ľ‚Đ؏œ‚ˇ‚é•ű–@1jCäNă÷•Ç‚đŠJ•ú‚š‚¸‚ÉççŽq‚Ĺ”cŽ‚ľŘœ‚ˇ‚é•ű–@2jCƒXƒe[ƒvƒ‰‚Č‚Ç‚ĹŘœ‚ˇ‚é•ű–@3j‚Č‚Ç‚Ş‚ ‚éB”äŠr“I’áNP‚Ĺ‚ ‚é‚ŞCäNă÷•Ç‚đŠJ•ú‚ľ‚Đ؏œ‚ˇ‚é•ű–@‚Ĺ‚Íp–ě‚Ö‚ĚŽîᇎU•z‚ށCäNă÷•Ç‚đŠJ•ú‚ľ‚Č‚˘•ű–@‚Ĺ‚Í•Ç“ŕ”AŠÇ‚Ě•sŠŽ‘SŘœ‚âˆŮ•¨‚É‚ć‚錋ÎŒ`Ź‚Č‚Ç‚ŞŠëœœ‚ł‚ę‚éB

äNă÷“ŕƒAƒvƒ[ƒ`‚́CäNă÷ŘŠJ‚ĚŒăCäNă÷“ŕ‚ć‚č”AŠÇŒű‚𒟐ڊm”F‚ľC‚ť‚ĚŽü•ÓäNă÷”S–Œ‚Š‚çäNă÷ŠO‚ÉŒü‚Ż‚Đ؊J‚đ‰Á‚Ś‚é•ű–@4j‚Ĺ‚ ‚éBŠmŽŔ‚ÉäNă÷•Ç“ŕ”AŠÇ‚̐؏œ‚މ”\‚Ĺ‚ ‚é‚ŞC‚â‚âNPŤ‚ލ‚‚­C‚Ü‚˝ŽîᇎU•z‚ފ뜜‚ł‚ę‚éB

“ŕŽ‹‹ž“IƒAƒvƒ[ƒ`‚́Cpluck –@‚Ć‚ŕŒÄ‚΂ęCŒo”A“š“I‚É”AŠÇŒűŽü•Ó”S–Œ‚Š‚çäNă÷ŠO‚ÉŒü‚Ż‚Đ؊J‚đ‰Á‚Ś‚é•ű–@5j‚Ĺ‚ ‚é‚ŞC• o‹žççŽq‚Ĺ•â•‚ˇ‚é•ű–@6j‚âC“ÁŽę‚Č•ű–@‚Ć‚ľ‚Ä”AŠÇ‚đ”˝“]‚ł‚šŒo”A“š“I‚ɉ“ˆĘ”AŠÇ‚Ě‚Ý‚đˆř‚Ť”˛‚­stripping –@7j‚Ş‚ ‚éB’áNP‚Ĺ‚ ‚é‚ŞCŽîᇎU•z‚ފ뜜‚ł‚ę‚éB

äNă÷“ŕƒAƒvƒ[ƒ`‚ÍŠJ•úŽčp‚ōs‚í‚ę‚é‚ŞCäNă÷ŠOƒAƒvƒ[ƒ`‚¨‚ć‚Ń“ŕŽ‹‹ž“IƒAƒvƒ[ƒ`‚ÍŠJ•úŽčpC• o‹ž‰şŽčp‚˘‚¸‚ę‚Ĺ‚ŕŽ{s‰Â”\‚Ĺ‚ ‚éB

‚ą‚ę‚çäNă÷•”•ŞŘœpŽŽŠÔ‚̐§ŠŕŒř‰Ę‚Č‚ç‚Ń‚É’áNPŤ“™‚𒟐ڔäŠr‚ľ‚˝‘OŒü‚ŤŒ¤‹†‚Í‘śÝ‚š‚¸C‘˝‚­‚ŞŒŔ‚ç‚ę‚˝Ç—ᐔ‚đ—p‚˘‚˝Œă‚ëŒü‚ŤŒ¤‹†‚Ě•ń‚Ĺ‚ ‚čCpŽŽŠÔ‚Ĺ–ž‚ç‚Š‚Č—LˆÓˇ‚đ”F‚ß‚Č‚˘‚Ć‚ł‚ę‚Ä‚˘‚é1j3j4jB‹ß”NC2,681 —á‚Ě‘ĺ‹K–Í‚ČŒă‚ëŒü‚Ť‘˝Ž{Ý‹¤“ŻŒ¤‹†‚ލs‚í‚ęCpŽŽŠÔ‚Ĺ‘Sś‘ś—ŚCŠŕ“ÁˆŮ“Iś‘ś—ŚCäNă÷“ŕÄ”­‚đœ‚­–łÄ”­ś‘ś—Ś‚É—LˆÓˇ‚đ”F‚ß‚Č‚Š‚Á‚˝‚ށC“ŕŽ‹‹ž“IƒAƒvƒ[ƒ`‚ÍäNă÷“ŕ‚¨‚ć‚ŃäNă÷ŠOƒAƒvƒ[ƒ`‚Ć”äŠr‚ľ—LˆÓ‚ÉäNă÷“ŕÄ”­—Ś‚ލ‚‚˘‚Ć•ń‚ł‚ę‚Ä‚˘‚éi‚ť‚ę‚ź‚ę‚T”N”ńäNă÷“ŕÄ”­—Ś40%C71%C64%j2jB

ŒťŽž“_‚ł́C‹ÇŠÄ”­EŽîᇔdŽí‚̉”\Ť‚âCŠłŽŇ‚É—^‚Ś‚éNPŤCpŽŇ‚ĚŒoŒą’l“™‚đ‘‡“I‚É”ť’f‚ľ‚āCŒÂX‚ĚÇ—á‚˛‚Ć‚ÉäNă÷•”•ŞŘœpŽŽ‚đŒŸ“˘‚ˇ‚é‚ą‚Ć‚Ş–]‚Ü‚ę‚éB

ŽQl•śŒŁ

1j Ritch CR, Kearns JT, Mues AC, et al. Comparison of distal ureteral management strategies during laparoscopic nephroureterectomy. J Endourol. 2011; 25: 1149-54.

2j Xylinas E, Rink M, Cha EK, et al. Impact of distal ureter management on oncologic outcomes following radical nephroureterectomy for upper tract urothelial carcinoma. Eur Urol. 2014; 65: 210-7.

3j Hattori R, Yoshino Y, Gotoh M, Katoh M, Kamihira O, Ono Y. Laparoscopic nephroureterectomy for transitional cell carcinoma of renal pelvis and ureter: Nagoya experience. Urology. 2006; 67: 701-5.

4j Li WM, Shen JT, Li CC, et al. Oncologic outcomes following three different approaches to the distal ureter and bladder cuff in nephroureterectomy for primary upper urinary tract urothelial carcinoma. Eur Urol. 2010; 57: 963-9.

5j Gkougkousis EG, Mellon JK, Griffiths TR. Management of the distal ureter during nephroureterectomy for upper urinary tract transitional cell carcinoma: a review. Urol Int. 2010; 85: 249-56.

6j Matin SF, Gill IS. Recurrence and survival following laparoscopic radical nephroureterectomy with various forms of bladder cuff control. J Urol. 2005; 173: 395-400.

7j Giovansili B, Peyromaure M, Saïghi D, Dayma T, Zerbib M, Debré B. Stripping technique for endoscopic management of distal ureter during nephroureterectomy: experience of 32 procedures. Urology. 2004; 64: 448-52.


CQ8
tṁE”AŠÇ‚ĚŒ´”­ŤCISiă”ç“ŕŠŕj‚ɐt”AŠÇ‘S“EœpEäNă÷•”•ŞŘœp‚͐„§‚ł‚ę‚é‚Š?

Answer

‘Α¤‚ÉŒ’ít‚đ—L‚ˇ‚é•Đ‘¤tṁE”AŠÇ‚ĚŒ´”­ŤCIS ‚ɑ΂ľ‚āCt”AŠÇ‘S“EœpEäNă÷•”•ŞŘœp‚͐„§‚ł‚ę‚épŽŽ‚Ĺ‚ ‚éi„§ƒOƒŒ[ƒhBjB

‰đ ŕ

tṁE”AŠÇ‚ĚŒ´”­ŤCISiă”ç“ŕŠŕj‚É’–Ú‚ľC‚ť‚ĚŽĄ—ÐŹŃ‚đŒŸ“˘‚ľ‚˝•ń‚͋ɂ߂ď­‚Č‚˘‚Ě‚ŞŒťó‚Ĺ‚ ‚éB

Karam ‚ç‚Í1987 ”N‚Š‚ç2007 ”N‚Ü‚Ĺ‚ÉŽ{s‚ł‚ę‚˝t”AŠÇ‘S“EœpEäNă÷•”•ŞŘœpÇ—á1,363 —á‚đŒă‚ëŒü‚Ť‚ÉŠĎŽ@‚ľC28 —ái2%j‚ɐtṁE”AŠÇ‚ĚŒ´”­ŤCIS Ç—á‚đ”F‚ß‚˝‚Ć‚ľ‚Ä‚˘‚éB‚R”N”ńÄ”­—Ś‚Í84%C‚R”NŠŕ“ÁˆŮ“Iś‘ś—Ś‚Í89%CŠĎŽ@ŠúŠÔ‚Ě’†‰›’l‚Í42.8 ƒ•ŒŽ‚ŁCŠŕŽ€‚Í‚R—á‚Ě‚Ý‚Ĺ‚ ‚Á‚˝‚Ć—ÇD‚ČŒ‹‰Ę‚đ•ń‚ľ‚Ä‚˘‚é1jB

Yuasa ‚ç‚́CŒă‚ëŒü‚Ť‚ɏWŒv‚ł‚ę‚˝tṁE”AŠÇ‚ĚŒ´”­ŤCIS ‚W—á‚ɑ΂ˇ‚ét”AŠÇ‘S“EœpEäNă÷•”•ŞŘœp‚ĚŽĄ—ÐŹŃ‚ɂ‚˘‚Ä•ń‚ľ‚Ä‚˘‚é2jBŠĎŽ@ŠúŠÔ‚Ě’†‰›’l‚Í56 ƒ•ŒŽ‚ŁC‚T—á‚ÉäNă÷“ŕÄ”­‚đ”F‚ß‚˝‚ŕ‚Ě‚ĚŠŕŽ€—á‚Í‚Ý‚ç‚ę‚Č‚Š‚Á‚˝‚Ć‚ľ‚Ä‚˘‚éB

ˆę•ű‚ŁCtṁE”AŠÇ‚ĚŒ´”­ŤCIS Ç—á‚ɑ΂ˇ‚ét”AŠÇ‘S“EœpEäNă÷•”•ŞŘœp‚ĆBCG ‚Ěă•””A˜H’“ü—Ă–@‚Ě”äŠr‚É‚¨‚˘‚āC’ˇŠú‚̐§ŠŕŒř‰Ę‚ɍˇ‚đ”F‚ß‚Č‚˘‚Ć‚ˇ‚é•ń‚ŕ‚Ý‚ç‚ę‚éBKojima ‚ç‚Í17 —á‚̐tṁE”AŠÇ‚ĚŒ´”­ŤCIS Ç—á‚ɑ΂ľCt”AŠÇ‘S“EœpEäNă÷•”•ŞŘœp‚ ‚邢‚ÍBCG ‚Ěă•””A˜H’“ü—Ă–@‚đŽ{s‚ľ‚˝Œ‹‰Ę‚đŒă‚ëŒü‚Ť‚ÉŒŸ“˘‚ľ‚Ä‚¨‚čC’†‰›’l58 ƒ•ŒŽ‚ĚŠĎŽ@ŠúŠÔ‚Ĺ”ńÄ”­—ŚCŠŕ“ÁˆŮ“Iś‘ś—Ś‚ÉŠÖ‚ľ—źŒQŠÔ‚É—LˆÓˇ‚Í‚Č‚Š‚Á‚˝‚Ć‚ľ‚Ä‚˘‚é3jBˆČă‚ć‚čBCG ‚Ěă•””A˜H’“ü—Ă–@‚É‚ć‚č’ˇŠú‚̐§ŠŕŒř‰Ę‚đ”F‚ß‚é‚Ć‚ˇ‚é•ń‚ŕ‚ ‚é‚ŞCŒťŽž“_‚Ĺ‚ÍƒGƒrƒfƒ“ƒX‚Ş•s\•Ş‚Ĺ‚ ‚čŒ‹˜_‚Ş“ž‚ç‚ę‚Ä‚˘‚Č‚˘B

CIS ‚đ”ş‚ˇ‚éC”şCIS tṁE”AŠÇŠŕÇ—á‚ɑ΂ˇ‚ét”AŠÇ‘S“EœpEäNă÷•”•ŞŘœp‚ĚŽĄ—ÐŹŃ‚ÉŠÖ‚ˇ‚é•ń‚ÍŒťÝ‚Ü‚Ĺ‚É‚˘‚­‚‚ŠŽUŒŠ‚ł‚ę‚é4j|7jB“Eo•W–{‚É‚¨‚Ż‚鐏”şCIS ‚Ě‘śÝ‚Í—LˆÓ‚Č—\Œă•s—LjöŽq‚Ć‚ľ‚Ä•ń‚ł‚ę‚Ä‚˘‚éB

ŽQl•śŒŁ

1j Karam JA, Margulis V, Montorsi F, et al. Carcinoma in situ of the upper urinary tract treated with radical nephroureterectomy--results from a multicenter study. Eur Urol. 2008; 54: 961-3.

2j Yuasa T, Tsuchiya N, Narita S, et al. Radical nephroureterectomy as initial treatment for carcinoma in situ of upper urinary tract. Urology. 2006; 68: 972-5.

3j Kojima Y, Tozawa K, Kawai N, Sasaki S, Hayashi Y, Kohri K. Long-term outcome of upper urinary tract carcinoma in situ: effectiveness of nephroureterectomy versus bacillus Calmette-Guérin therapy. Int J Urol. 2006; 13: 340-4.

4j Wheat JC, Weizer AZ, Wolf JS Jr., et al. Concomitant carcinoma in situ is a feature of aggressive disease in patients with organ confined urothelial carcinoma following radical nephroureterectomy. Urol Oncol. 2012; 30: 252-8.

5j Otto W, Shariat SF, Fritsche HM, et al. Concomitant carcinoma in situ as an independent prognostic parameter for recurrence and survival in upper tract urothelial carcinoma: a multicenter analysis of 772 patients. World J Urol. 2011; 29: 487-94.

6j Cha EK, Shariat SF, Kormaksson M, et al. Predicting clinical outcomes after radical nephroureterectomy for upper tract urothelial carcinoma. Eur Urol. 2012; 61: 818-25.

7j Pieras E, Frontera G, Ruiz X, Vicens A, Ozonas M, Pizá P. Concomitant carcinoma in situ and tumour size are prognostic factors for bladder recurrence after nephroureterectomy for upper tract transitional cell carcinoma. BJU Int. 2010; 106: 1319-23.


CQ9
t”AŠÇ‘S“EœpEäNă÷•”•ŞŘœp‚É‚¨‚˘‚ďp‘O‚ ‚邢‚͏pŒă•â•‰ťŠw—Ă–@‚͐„§‚ł‚ę‚é‚Š?

Answer

pT3ˆČă‚Ü‚˝‚ÍpN+Ç—á‚̐tṁE”AŠÇŠŕ‚ɑ΂ľ‚ẮCpŒă•â•‰ťŠw—Ă–@‚đl—ś‚ľ‚Ä‚ŕ‚悢i„§ƒOƒŒ[ƒhC1jB

‰đ ŕ

tṁE”AŠÇŠŕÇ—á‚́C–łěˆ×‰ť”äŠrŽŽŒą‹s‚ދɂ߂袓ď‚Ĺ‚ ‚é‚˝‚ߏ\•Ş‚ČƒGƒrƒfƒ“ƒX‚Ě‚ ‚é•ń‚Í’˛‚דž‚˝ŒŔ‚č‘śÝ‚ľ‚Č‚˘BŽüpŠú•â•‰ťŠw—Ă–@‚ɂ‚˘‚Ä‚Ě—Bˆę‚Ě‘OŒü‚ŤŽŽŒą‚Ć‚ľ‚ÄBamias ‚ç‚ÍpaclitaxelCcarboplatin ‚đ—p‚˘‚˝phase Ⅱ study ‚É‚¨‚˘‚āCpŒă•â•‰ťŠw—Ă–@‚ŞpT3 ˆČă‚Ü‚˝‚ÍpN+ Ç—á‚̐tṁE”AŠÇŠŕ‚̏pŒă‰“Šu“]ˆÚ‚ĚƒŠƒXƒN‚đŒ¸­‚ľ“ž‚é‚Ć•ń‚ľ‚Ä‚˘‚é1jB‚Ü‚˝pŒă•â•‰ťŠw—Ă–@‚É‚ć‚čäNă÷“ŕÄ”­‚ŞŒ¸­‚ľ‚˝‚Ć‚˘‚¤•ń‚ŕ‚ ‚é2jBˆę•űCpŒă•â•‰ťŠw—Ă–@‚Í—\Œă‰ü‘PŒř‰Ę‚đ”F‚ß‚Č‚Š‚Á‚˝‚Ć‚ˇ‚éŒă‚ëŒü‚ŤŒŸ“˘Œ‹‰Ę‚ŕ‘śÝ‚ˇ‚é3j4jB

ŽüpŠú‰ťŠw—Ă–@‚Ć‚ľ‚āCp‘O‚ƏpŒă‚Ě‚Ç‚ż‚ç‚Ş‚悢‚Š‚ɂ‚˘‚Ä‚Í–žŠm‚ČƒGƒrƒfƒ“ƒX‚Í‘śÝ‚ľ‚Č‚˘Bp‘O•â•‰ťŠw—Ă–@‚ĚƒƒŠƒbƒg‚Ć‚ľ‚Ä“Ż‚ś”A˜Hă”çŠŕ‚Ĺ‚ ‚éZŤäNă÷Šŕ‚ł́CäNă÷‘S“Eœp‘O•â•‰ťŠw—Ă–@‚Ş’ˇŠú—\Œă‚đ‰ü‘P‚ˇ‚é‚Ć‚˘‚¤ƒGƒrƒfƒ“ƒX‚ŞŽŚ‚ł‚ę‚Ä‚˘‚é‚ą‚ƁCŠł‘¤t“Eœ‚É‚ć‚ét‹@”\’ቺ‚đ‰ń”đ‚ľ‚˝ó‘Ô‚Ĺcisplatin ƒx[ƒX‚̉ťŠw—Ă–@‚ŞŽ{s‰Â”\‚Ĺ‚ ‚é‚ą‚ƁC‰ťŠw—Ă–@‚ĚŽĄ—ĂŒř‰Ę‚ޏpŒă‚Ě—\Œă—\‘ވöŽq‚Ć‚Č‚é‚ą‚Ć‚Č‚Ç‚Ş‹“‚°‚ç‚ę‚é5jBˆę•űCƒfƒƒŠƒbƒg‚Ć‚ľ‚Ä—\Œă•s—ǏǗáˆČŠO‚ĚÇ—á‚ɑ΂ľ‚Ä–ł—p‚ȉťŠw—Ă–@‚đs‚¤‰Â”\ŤCŽčp‚Ü‚Ĺ‚ĚŠúŠÔ‚މ„’ˇ‚ˇ‚é‚ą‚Ć‚Č‚Ç‚ŞŽw“E‚ł‚ę‚Ä‚˘‚éB

p‘O‰ťŠw—Ă–@‚ĚŽĄ—ĂŒř‰Ę‚ɂ‚˘‚ďd—v‚Čƒpƒ‰ƒ[ƒ^[‚Í•a—‘gDŠw“I‚Éviable cell ‚đ”F‚ß‚Č‚˘pathological Complete ResponseiˆČ‰şpCRj‚Ĺ‚ ‚éB‚ą‚ę‚Ü‚Ĺ‚Ě•ń‚ĹpCR ‚ĚŠ„‡‚́C‚Ů‚Ú13~15%‚Ĺˆę’v‚ľ‚Ä‚¨‚čCpCR Ç—á‚Ĺ‚Í—ÇD‚Č’ˇŠú—\Œă‚ŞŠú‘Ň‚Ĺ‚Ť‚é‚Ć‚ˇ‚é•ń‚Ş‘˝‚˘6j|8jBp‘O‚ɉťŠw—Ă–@‚Ş•K—v‚Ć‚ł‚ę‚éÇ—á‚𐳊m‚É—\‘Ş‚ˇ‚é‚ą‚Ć‚Í—eˆŐ‚Ĺ‚Í‚Č‚˘‚ށCśŒŸ‘gDgrade3 Ç—á‚ĚpT3 ˆČă‚Ě—zŤ“I’†—Ś‚Í42%C grade2 ˆČ‰ş‚̉AŤ“I’†—Ś‚Í92%‚Ć‚Ě•ń9j‚ŕ‚ ‚čCśŒŸ‚É‚ć‚égrade f’f‚̏d—vŤ‚𮦍´‚ľ‚Ä‚˘‚éBp‘O•â•‰ťŠw—Ă–@‚́C”AŠÇ‹žŒŸ¸‚É‚ć‚é‘gDf‚ ‚邢‚͍זEf‚ɂĐtṁE”AŠÇŠŕ‚ĚŠm’čf’f‚đs‚Á‚˝ă‚ĹŽ{s‚ˇ‚é‚ą‚Ć‚Ş–]‚Ü‚ľ‚˘B

ŽQl•śŒŁ

1j Bamias A, Deliveliotis C, Fountzilas G, et al. Adjuvant chemotherapy with paclitaxel and carboplatin in patients with advanced carcinoma of the upper urinary tract: a study by the Hellenic Cooperative Oncology Group. J Clin Oncol. 2004; 22: 2150-4.

2j Soga N, Arima K, Sugimura Y. Adjuvant methotrexate, vinblastine, adriamycin, and cisplatin chemotherapy has potential to prevent recurrence of bladder tumors after surgical removal of upper urinary tract transitional cell carcinoma. Int J Urol. 2008; 15: 800-3.

3j Lee SE, Byun SS, Park YH, Chang IH, Kim YJ, Hong SK. Adjuvant chemotherapy in the management of pT3N0M0 transitional cell carcinoma of the upper urinary tract. Urol Int. 2006; 77: 22-6.

4j Hellenthal NJ, Shariat SF, Margulis V, et al. Adjuvant chemotherapy for high risk upper tract urothelial carcinoma: results from the Upper Tract Urothelial Carcinoma Collaboration. J Urol. 2009; 182: 900-6.

5j Alva AS, Matin SF, Lerner SP, Siefker-Radtke AO. Perioperative chemotherapy for upper tract urothelial cancer. Nat Rev Urol. 2012; 9: 266-73.

6j Igawa M, Urakami S, Shiina H, et al. Neoadjuvant chemotherapy for locally advanced urothelial cancer of the upper urinary tract. Urol Int. 1995; 55: 74-7.

7j Matin SF, Margulis V, Kamat A, et al. Incidence of downstaging and complete remission after neoadjuvant chemotherapy for high-risk upper tract transitional cell carcinoma. Cancer. 2010; 116: 3127-34.

8j Rajput MZ, Kamat AM, Clavell-Hernandez J, et al. Perioperative outcomes of laparoscopic radical nephroureterectomy and regional lymphadenectomy in patients with upper urinary tract urothelial carcinoma after neoadjuvant chemotherapy. Urology. 2011; 78: 61-7.

9j Brown GA, Matin SF, Busby JE, et al. Ability of clinical grade to predict final pathologic stage in upper urinary tract transitional cell carcinoma: implications for therapy. Urology. 2007; 70: 252-6.


CQ10
t”AŠÇ‘S“EœpEäNă÷•”•ŞŘœpŒă‚ĚäNă÷“ŕÄ”­‚Ě•p“xC‚Ü‚˝‚ť‚Ě—\‘ވöŽq‚ɂ͂ǂ̂悤‚Č‚ŕ‚Ě‚Ş‚ ‚é‚Š?

Answer

t”AŠÇ‘S“EœpEäNă÷•”•ŞŘœpŒă‚ĚäNă÷“ŕÄ”­‚́C–ń15~50%‚É”F‚ß‚ç‚ę‚éB‚Ü‚˝CpŒă‚ĚäNă÷“ŕÄ”­‚đ—\‘Ş‚ˇ‚éˆöŽq‚Ć‚ľ‚āC‘˝”‚ĚŒó•âˆöŽq‚Ş•ń‚ł‚ę‚Ä‚˘‚é‚ŞCŠm—§‚ł‚ę‚˝äNă÷“ŕÄ”­—\‘ވöŽq‚Í‘śÝ‚ľ‚Č‚˘B

‰đ ŕ

”A˜Hă”çŠŕ‚Í‘S”A˜H‚É“ŻŽžŤCˆŮŽžŤ‚É”­Ç‚ˇ‚é‚Ć‚˘‚¤“Á’Ľ‚Ş‚ ‚é‚ŞCtṁE”AŠÇŠŕ‚É‚¨‚˘‚Ä‚ŕt”AŠÇ‘S“EœpEäNă÷•”•ŞŘœpŒă‚ɍ‚•p“x‚ÉäNă÷“ŕÄ”­‚đ‚Ť‚˝‚ˇ‚ą‚Ć‚Ş’m‚ç‚ę‚Ä‚˘‚éB‚˝‚ž‚ľC‚ť‚Ě•p“x‚Í•ń‚˛‚Ć‚Éˆę’č‚ľ‚Ä‚¨‚炸C–ń15~50%‚Ć‘ĺ‚Ť‚­ˆŮ‚Č‚Á‚Ä‚˘‚éB‚ľ‚Š‚ľCÄ”­‚Ü‚Ĺ‚ĚŠúŠÔ‚ɂ‚˘‚Ă͐t”AŠÇ‘S“EœpEäNă÷•”•ŞŘœpŒă–ń‚Q”NˆČ“ŕ‚ɍD”­‚ˇ‚é‚Ć‚Ě•ń‚Ş‘˝‚˘1jB

t”AŠÇ‘S“EœpEäNă÷•”•ŞŘœpŒă‚ĚäNă÷“ŕÄ”­‚đ—\‘Ş‚ˇ‚éˆöŽq‚ɂ‚˘‚ẮC‰ß‹Ž–c‘ĺ‚ČŒ¤‹†‚ލs‚í‚ę—lX‚ČŒó•âˆöŽq‚Ş•ń‚ł‚ę‚Ä‚˘‚é‚ŞCŒťŽž“_‚Ĺ‚ÍŠm—§‚ł‚ę‚˝—\‘ވöŽq‚⃊ƒXƒN•Ş—Ţ‚Í‘śÝ‚ľ‚Č‚˘1jB‚ť‚ĚŽĺ‚Č——R‚Ć‚ľ‚ẮCtṁE”AŠÇŠŕ‚Ş”äŠr“I‹H‚ČŽžŠł‚Ĺ‚ ‚é‚˝‚߁C‘OŒü‚Ť–łěˆ×‰ťŽŽŒą‚ĚŽŔŽ{‚ލ˘“ď‚Ĺ‚ ‚é‚ą‚ƁCŽčp•ű–@‚¨‚ć‚яpŒă•â•—Ă–@“™‚É‚¨‚˘‚āC‘˝—l‚ČŽĄ—Ă‘I‘đŽˆ‚Ş‘śÝ‚ˇ‚é‚˝‚ß•ń‚˛‚Ć‚ÉŠłŽŇ”wŒi‚Ş‘ĺ‚Ť‚­ˆŮ‚Č‚é‚ą‚Ć‚Ş‹“‚°‚ç‚ę‚éB

ŒťÝ‚Ü‚Ĺ‚É•ń‚ł‚ę‚Ä‚˘‚épŒăäNă÷“ŕÄ”­‚Ě—\‘ވöŽq‚Ě’†‚Ĺ—Ő°•a—Šw“IˆöŽq‚Ć‚ľ‚ẮCŽîᇐ”2j|4jCŽîᇌa4j|6jC•a—Šw“I•aŠú2j4jCŤ•Ę7j8jCäNă÷Šŕ‚ĚŠů‰‚Ě—L–ł5jCŽîᇕ”ˆĘ7jCŽîá‡grade1j‚¨‚ć‚ѐt‹@”\3j“™‚Ş‹“‚°‚ç‚ę‚éB‚ą‚ę‚ç‚ĚˆöŽq‚Ě’†‚ł́C‘˝”­Žîᇂ ‚邢‚ÍŒa‚Ě‘ĺ‚Ť‚ČŽîᇂށC•Ą”‚ĚŒ¤‹†‚Ĺ‘˝•Ď—ʉđÍ‚đ—p‚˘‚ÄäNă÷“ŕÄ”­‚ĚŠëŒŻˆöŽq‚Ć‚ľ‚Ä“Ż’č‚ł‚ę‚Ä‚¨‚č1j|6jC”äŠr“IM—ŠŤ‚̍‚‚˘äNă÷“ŕÄ”­—\‘ވöŽq‚Ĺ‚ ‚é‚ƍl‚Ś‚ç‚ę‚éB‚Ü‚˝Ct”AŠÇ‘S“EœpEäNă÷•”•ŞŘœp‚ĚŽčp—lŽŽ‚ŞäNă÷“ŕÄ”­‚É‹y‚Ú‚ˇ‰e‹ż‚̉đÍ‚ŕ‘˝”s‚í‚ę‚Ä‚˘‚éB‚ľ‚Š‚ľCˆę•”‚Ě—áŠO‚đœ‚ŤCŽčpƒAƒvƒ[ƒ`iŠJ•úŽčp‚ ‚邢‚Í• o‹žŽčpj9j|11j‚¨‚ć‚Ń”AŠÇ‰ş’[‚̏ˆ—•ű–@12j|14j‚Ě‚˘‚¸‚ę‚ŕCäNă÷“ŕÄ”­‚Ć‚ĚŠÖ˜A‚Í”F‚ß‚Č‚˘‚Ć•ń‚ł‚ę‚Ä‚˘‚éBˆę•űCpŒă•â•—Ă–@‚ĆäNă÷“ŕÄ”­‚Ć‚ĚŠÖ˜A‚ŕˆę•”‚ĹŒŸ“˘‚ł‚ę‚Ä‚˘‚é‚ŞC‘˝Ü•š—p‰ťŠw—Ă–@15j16j‚¨‚ć‚эRŠŕÜäNă÷“ŕ’“ü—Ă–@17j18j‚Ć‚ŕ‚ɁCäNă÷“ŕÄ”­‚ɑ΂ˇ‚é—\–hŒř‰Ę‚đ—L‚ˇ‚é‚Ć‚Ě•ń‚Ş‘˝‚˘B‚ł‚ç‚ɁCĹ‹ß‚Ĺ‚Í•ŞŽqƒ}[ƒJ[‚đ—p‚˘‚˝t”AŠÇ‘S“EœpEäNă÷•”•ŞŘœpŒă‚ĚäNă÷“ŕÄ”­—\‘Ş‚ŕŽŽ‚Ý‚ç‚ę‚Ä‚¨‚čCőF‘Ě‚â×–EÚ’…ˆöŽq‚ĚˆŮí‚ƏpŒăäNă÷“ŕÄ”­‚Ć‚ĚŠÖ˜A‚ŞŽw“E‚ł‚ę‚Ä‚˘‚é19j20jB

ˆČă‚Ě—lX‚ČˆöŽq‚Ě‘˝‚­‚́CŹ‹K–Í‚ĚŒă‚ëŒü‚ŤŒ¤‹†‚Ĺ“Ż’č‚ł‚ę‚Ä‚¨‚čCŒťŽž“_‚Őt”AŠÇ‘S“EœpEäNă÷•”•ŞŘœpŒă‚ĚäNă÷“ŕÄ”­‚đ—\‘Ş‚ˇ‚éM—ŠŤ‚̍‚‚˘Šm—§‚ł‚ę‚˝ˆöŽq‚Í‘śÝ‚ľ‚Č‚˘B]‚Á‚āCĄŒă‰Â”\‚ČŒŔ‚芳ŽŇ”wŒi‚đ‘ľ‚Ś‚˝‘ĺ‹K–Í‘OŒü‚ŤŒ¤‹†‚đs‚˘C‚ć‚č—D‚ę‚˝äNă÷“ŕÄ”­ˆöŽq‚Ě’Tő‚ÉŒü‚Ż‚˝“w—Í‚Ş‹‚ß‚ç‚ę‚éB

ŽQl•śŒŁ

1j Azémar MD, Comperat E, Richard F, Cussenot O, Rouprêt M. Bladder recurrence after surgery for upper urinary tract urothelial cell carcinoma: frequency, risk factors, and surveillance. Urol Oncol. 2011; 29: 130-6.

2j Terakawa T, Miyake H, Muramaki M, Takenaka A, Hara I, Fujisawa M. Risk factors for intravesical recurrence after surgical management of transitional cell carcinoma of the upper urinary tract. Urology. 2008; 71: 123-7.

3j Hirano D, Okada Y, Nagane Y, et al. Intravesical recurrence after surgical management of urothelial carcinoma of the upper urinary tract. Urol Int. 2012; 89: 71-7.

4j Matsui Y, Utsunomiya N, Ichioka K, et al. Risk factors for subsequent development of bladder cancer after primary transitional cell carcinoma of the upper urinary tract. Urology. 2005; 65: 279-83.

5j Novara G, De Marco V, Dalpiaz O, et al. Independent predictors of metachronous bladder transitional cell carcinoma iTCCj after nephroureterectomy for TCC of the upper urinary tract. BJU Int. 2008; 101: 1368-74.

6j Pieras E, Frontera G, Ruiz X, Vicens A, Ozonas M, Pizá P. Concomitant carcinoma in situ and tumour size are prognostic factors for bladder recurrence after nephroureterectomy for upper tract transitional cell carcinoma. BJU Int. 2010; 106: 1319-23.

7j Kusuda Y, Miyake H, Terakawa T, Kondo Y, Miura T, Fujisawa M. Gender as a significant predictor of intravesical recurrence in patients with urothelial carcinoma of the upper urinary tract following nephroureterectomy. Urol Oncol. 2013; 31: 899-903.

8j Huang WW, Huang HY, Liao AC, et al. Primary urothelial carcinoma of the upper tract: important clinicopathological factors predicting bladder recurrence after surgical resection. Pathol Int. 2009; 59: 642-9.

9j Rassweiler JJ, Schulze M, Marrero R, Frede T, Palou Redorta J, Bassi P. Laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma: is it better than open surgery? Eur Urol. 2004; 46: 690-7.

10j Manabe D, Saika T, Ebara S, et al. Comparative study of oncologic outcome of laparoscopic nephroureterectomy and standard nephroureterectomy for upper urinary tract transitional cell carcinoma. Urology. 2007; 69: 457-61.

11j Chung SD, Huang CY, Chueh SC, et al. Intermediate follow-up of hand-assisted retroperitoneoscopic nephroureterectomy for management of upper urinary tract urothelial carcinoma: comparison with open nephroureterectomy. Urology. 2007; 69: 1030-4.

12j Li WM, Shen JT, Li CC, et al. Oncologic outcomes following three different approaches to the distal ureter and bladder cuff in nephroureterectomy for primary upper urinary tract urothelial carcinoma. Eur Urol. 2010; 57: 963-9.

13j Matin SF, Gill IS. Recurrence and survival following laparoscopic radical nephroureterectomy with various forms of bladder cuff control. J Urol. 2005; 173: 395-400.

14j Salvador-Bayarri J, Rodríguez-Villamil L, Imperatore V, Palou Redorta J, Villavicencio-Mavrich H, Vicente-Rodríguez J. Bladder neoplasms after nephroureterectomy: does the surgery of the lower ureter, transurethral resection or open surgery, influence the evolution? Eur Urol. 2002; 41: 30-3.

15j Ku JH, Choi WS, Kwak C, Kim HH. Bladder cancer after nephroureterectomy in patients with urothelial carcinoma of the upper urinary tract. Urol Oncol. 2011; 29: 383-7.

16j Soga N, Arima K, Sugimura Y. Adjuvant methotrexate, vinblastine, adriamycin, and cisplatin chemotherapy has potential to prevent recurrence of bladder tumors after surgical removal of upper urinary tract transitional cell carcinoma. Int J Urol. 2008; 15: 800-3.

17j OfBrien T, Ray E, Singh R, Coker B, Beard R; British Association of Urological Surgeons Section of Oncology. Prevention of bladder tumours after nephroureterectomy for primary upper urinary tract urothelial carcinoma: a prospective, multicentre, randomised clinical trial of a single postoperative intravesical dose of mitomycin C ithe ODMIT-C Trialj. Eur Urol. 2011; 60: 703-10.

18j Wu WJ, Ke HL, Yang YH, Li CC, Chou YH, Huang CH. Should patients with primary upper urinary tract cancer receive prophylactic intravesical chemotherapy after nephroureterectomy? J Urol. 2010; 183: 56-61.

19j Akao J, Matsuyama H, Yamamoto Y, Sasaki K, Naito K. Chromosome 20q13.2 gain may predict intravesical recurrence after nephroureterectomy in upper urinary tract urothelial tumors. Clin Cancer Res. 2006; 12: 7004-8.

20j Muramaki M, Miyake H, Terakawa T, Kusuda Y, Fujisawa M. Expression profile of E-cadherin and N-cadherin in urothelial carcinoma of the upper urinary tract is associated with disease recurrence in patients undergoing nephroureterectomy. Urology. 2011; 78: 1443 e7-12.


CQ11
t”AŠÇ‘S“EœpEäNă÷•”•ŞŘœpŒă‚ĚƒtƒHƒ[ƒAƒbƒv‚ĚŰ‚É„§‚ł‚ę‚錟¸‚͉˝‚Š?

Answer

–žŠm‚ČƒtƒHƒ[ƒAƒbƒvƒvƒƒgƒR[ƒ‹‚Í‘śÝ‚ľ‚Č‚˘‚ށC’čŠú“I‚ČCTŒŸ¸‚É‚ć‚é‹ÇŠÄ”­E‰“Šu“]ˆÚ‚Ě”­śC‘Α¤ă•””A˜HÄ”­‚Ě•]‰ż‚Í•K—v‚Ĺ‚ ‚éB‚Ü‚˝äNă÷‹žŒŸ¸E”A×–Ef‚É‚ć‚éäNă÷“ŕÄ”­‚Ě—L–ł‚ĚŠm”F‚đs‚¤‚ą‚Ƃ͐„§‚ł‚ę‚éi„§ƒOƒŒ[ƒhBjB

‰đ ŕ

ƒtƒHƒ[ƒAƒbƒv‚ÉŠÖ‚ˇ‚錟“˘˜_•ś‚Í‚Ů‚Ć‚ń‚Ç‚Č‚­CƒGƒrƒfƒ“ƒX‚ÉŠî‚Ă‚˘‚˝ƒtƒHƒ[ƒAƒbƒvƒvƒƒgƒR[ƒ‹‚ÍŒťÝ‚Ě‚Ć‚ą‚ë‘śÝ‚ľ‚Č‚˘BtṁE”AŠÇŠŕpŒă‚͋ǏŠÄ”­E‰“Šu“]ˆÚ‚Ş–ń25%‚ɐś‚ś1j2jCäNă÷“ŕÄ”­‚Ş15~50%’ö“x‚É”­ś‚ˇ‚é‚ą‚Ć‚Ş’m‚ç‚ę‚Ä‚˘‚é3jBƒtƒHƒ[ƒAƒbƒv‚đl‚Ś‚éă‚ĹäNă÷“ŕÄ”­‚́C‰“Šu“]ˆÚ‚â‹ÇŠÄ”­‚Ć‚Í–žŠm‚É‹ć•Ę‚ľ‚čl‚Ś‚é‚Ě‚Şˆę”Ę“I‚Ĺ‚ ‚éB‚Ü‚˝C‚ą‚ę‚ç‚Ě”­ś‚Í‚Ç‚ĚÇ—á‚É‚ŕ‹Ďˆę‚É”­ś‚ˇ‚é‚í‚Ż‚Ĺ‚Í‚Č‚˘‚ą‚Ć‚Š‚çC“–‘RC‚ť‚ę‚ź‚ę‚ĚÇ—á‚ĚƒŠƒXƒN‚̍‚’á‚ɍ‡‚í‚š‚˝ƒtƒHƒ[ƒAƒbƒv‚ĚŒv‰ć‚𗧂Ăé‚ׂŤ‚Ĺ‚ ‚éB

‰“Šu“]ˆÚ‚Ě”­ś‚ÉŠÖ‚ľ‚ẮC‘˝”‚ĚÇ—á‚đWĎ‚ľŒă‚ëŒü‚Ť‚ɉđÍ‚ľ‚˝t”AŠÇ‘S“EœpEäNă÷•”•ŞŘœpŒă‚̐ś‘ś—Ś‚đ—\‘z‚ˇ‚éƒmƒ‚ƒOƒ‰ƒ€‚Ş‚˘‚­‚‚Š•ń‚ł‚ę‚Ä‚˘‚é4j5jB‚˘‚¸‚ę‚Ě•ń‚É‚¨‚˘‚Ä‚ŕ•a—•aŠú‚ÍĹ‚ŕŠŕ“ÁˆŮś‘ś—Ś—\‘ނɉe‹ż‚ˇ‚é‚ŕ‚Ě‚Ĺ‚ ‚čCŽŔŰC2013 ”NEAU ƒKƒCƒhƒ‰ƒCƒ“‚É‚¨‚˘‚Ä‚ŕ‹Ř‘w”ńZŤŠŕ‚Ć‹Ř‘wZŤŠŕ‚É•Ş‚Ż‚ătƒHƒ[ƒAƒbƒvƒvƒƒgƒR[ƒ‹‚Ş’ńŽŚ‚ł‚ę‚Ä‚¨‚čC‹Ř‘w”ńZŤŠŕÇ—á‚Ĺ‚Í–ˆ”NCT ŒŸ¸‚đs‚¤‚ą‚ƁC‹Ř‘wZŤŠŕÇ—á‚Ĺ‚ÍĹ‰‚Ě‚Q”N‚Í”ź”N‚˛‚Ć‚ÉCT urography ‚đs‚˘C‚ť‚ĚŒă‚Í–ˆ”Ns‚¤‚ą‚Ć‚Ş„§‚ł‚ę‚Ä‚˘‚é6jB

äNă÷“ŕÄ”­‚ÉŠÖ‚ľ‚ẮCäNă÷“ŕÄ”­‚Ş15~50%‚É”­ś‚ˇ‚é‚ą‚Ć‚Ş•ń‚ł‚ę‚Ä‚˘‚é‚ą‚Ć‚Š‚çCäNă÷‹žC”A×–Ef‚Ć‚˘‚Á‚˝ŒŸ¸‚Í‘S—á‚É•K{‚Ĺ‚ ‚éBŒŸ¸‚ĚƒXƒPƒWƒ…[ƒ‹‚ÉŠÖ‚ľ‚Ä‚Í2013 ”NEAU ƒKƒCƒhƒ‰ƒCƒ“‚É‚ÍŽčpŒă‚Rƒ•ŒŽ–ځC‚ť‚ĚŒă‚Í–ˆ”N‚Ć‹L‚ł‚ę‚Ä‚˘‚é6jBˆę•ű‚ŁC‚ć‚č•p‰ń‚ĚŒŸ¸‚Ş•K—v‚Ć‚˘‚¤ˆÓŒŠ‚ŕ‚ ‚čCƒGƒrƒfƒ“ƒX‚ÉŠî‚Ă‚˘‚˝ƒtƒHƒ[ƒAƒbƒvƒvƒƒgƒR[ƒ‹‚ĚŠm—§‚Ş–]‚Ü‚ę‚Ä‚˘‚é3jB

‘Α¤‚Ěă•””A˜H‚Ö‚ĚÄ”­‚ŕ’ˆÓ‚ˇ‚ׂŤ–â‘č‚Ĺ‚ ‚éB‘Α¤‚Ěă•””A˜H‚Ö‚ĚˆŮŽžŤÄ”­‚́CĹ‰‚̐t”AŠÇ‘S“EœpEäNă÷•”•ŞŘœpˆČ‘O‚ÉäNă÷Šŕ‚ĚŠů‰‚Ě‚ ‚éÇ—áC“Á‚ɐZŤäNă÷Šŕ‚ĚŠů‰‚đ—L‚ˇ‚éÇ—á‚Ĺ‚ť‚ĚƒŠƒXƒN‚ލ‚‚­‚Č‚é‚ą‚Ć‚Ş•ń‚ł‚ę‚Ä‚˘‚é7jB

ĄŒăCÄ”­—ŚCś‘ś—Ś‚Č‚Ç‚Ě—\Œă“I‘¤–Ę‚ž‚Ż‚Ĺ‚Č‚­ˆă—ĂŒoĎ“I‚Č‘¤–Ę‚ŕŠÜ‚߁CƒGƒrƒfƒ“ƒX‚ÉŠî‚Ă‚˘‚˝ƒtƒHƒ[ƒAƒbƒvƒXƒPƒWƒ…[ƒ‹‚ĚŠm—§‚Ş–]‚Ü‚ę‚éB

ŽQl•śŒŁ

1j Margulis V, Shariat SF, Matin SF, et al. Outcomes of radical nephroureterectomy: a series from the Upper Tract Urothelial Carcinoma Collaboration. Cancer. 2009; 115: 1224-33.

2j Rink M, Sjoberg D, Comploj E, et al. Risk of cancer-specific mortality following recurrence after radical nephroureterectomy. Ann Surg Oncol. 2012; 19: 4337-44.

3j Azémar MD, Comperat E, Richard F, Cussenot O, Rouprêt M. Bladder recurrence after surgery for upper urinary tract urothelial cell carcinoma: frequency, risk factors, and surveillance. Urol Oncol. 2011; 29: 130-6.

4j Yates DR, Hupertan V, Colin P, et al. Cancer-specific survival after radical nephroureterectomy for upper urinary tract urothelial carcinoma: proposal and multi-institutional validation of a post-operative nomogram. Br J Cancer. 2012; 106: 1083-8.

5j Cha EK, Shariat SF, Kormaksson M, et al. Predicting clinical outcomes after radical nephroureterectomy for upper tract urothelial carcinoma. Eur Urol. 2012; 61: 818-25.

6j Rouprêt M, Babjuk M, Compérat E, et al. European guidelines on upper tract urothelial carcinomas: 2013 update. Eur Urol. 2013; 63: 1059-71.

7j Novara G, De Marco V, Dalpiaz O, et al. Independent predictors of contralateral metachronous upper urinary tract transitional cell carcinoma after nephroureterectomy: multi-institutional dataset from three European centers. Int J Urol. 2009; 16: 187-91.


CQ12
”AŠÇ‹ž‰şt‰ˇ‘śŽčp‚͂ǂ̂悤‚ČÇ—á‚É“K‰ž‚Ć‚Č‚é‚Š?

Answer

’Pt‚ ‚邢‚Í—ź‘¤Ť‚É”­ś‚ľ‚˝‹ÇŠŒŔ‹ÇŤtṁE”AŠÇŠŕC‚Ü‚˝t‹@”\áŠQ‚ ‚邢‚ÍPS ‚Ş•s—Ç‚ČÇ—á‚ɑ΂ľ‚Đt‹@”\‰ˇ‘śC“§Í“ą“ü‰ń”đ‚Ě–Ú“I‚ɐt‰ˇ‘śŽčp‚͍l—ś‚ł‚ę‚鎥—Ă–@‚Ĺ‚ ‚éi„§ƒOƒŒ[ƒhC1jB

‰đ ŕ

t‰ˇ‘śŽčp‚́C“”AŠÇ‹ž‰ş‚ÉHolmium:YAG laser ‚âNd:YAG laser ‚đ—p‚˘‚Ä‹ĂŒĹCöŽU‚ł‚š‚é•ű–@‚ވę”Ę“I‚Ĺ‚ ‚é‚ŞC”AŠÇ‹ž‚Ĺ‚ĚƒAƒNƒZƒX‚ލ˘“ď‚Ȑt”t‚ĚŽîᇂɑ΂ľ‚Ä‚ÍŒo”ç“IƒAƒvƒ[ƒ`‚Ş‘I‘đ‚ł‚ę‚éę‡‚ŕ‚ ‚éB

Low gradeClow stage ‚̐tṁE”AŠÇŠŕ‚ɑ΂ľ‚Ä”AŠÇ‹žŽĄ—Ă‚É‚ć‚čt‰ˇ‘śŽčp‚đs‚Á‚˝•ń‚É‚ć‚é‚ƁC‚T”N”ńÄ”­—Ś‚Í13~54%C‚ť‚ĚŒăt”AŠÇ‘S“EœpEäNă÷•”•ŞŘœp‚đŽ{s‚ľ‚˝Ç—á‚Í10~33%‚Ĺ‚ ‚č1j|13jCŽîá‡gradeC‘˝’†SŤ•a•Ď‚Ě—L–łCŽîᇌaCäNă÷Šŕ‚ĚŠů‰—đ‚Ě—L–ł‚ލĔ­—Ś‚ɉe‹ż‚đ—^‚Ś‚éˆöŽq‚Ĺ‚ ‚Á‚˝6j9j|11jB’ˇŠúŒo‰ßŠĎŽ@‚đs‚Á‚˝ŒŸ“˘‚É‚ć‚é‚ƁCtṁE”AŠÇŠŕ‚Ě”ńÄ”­—Ś‚́C‚T”N‚Ĺ53.4%C10”N‚Ĺ20.5%‚Ć‚T”NˆČ~‚Ĺ‚ŕÄ”­‚Ş‹N‚ą‚č“ž‚é‚ą‚Ć‚ŞŽŚ‚ł‚ęC’ˇŠú‚ĚŒo‰ßŠĎŽ@‚Ş•K—v‚Ĺ‚ ‚é‚Ć•ń‚ł‚ę‚Ä‚˘‚é6jB‚Ü‚˝C‚T”NäNă÷“ŕ”ńÄ”­—Ś‚Í46~54%‚Ĺ‚ ‚é‚Ć‚ł‚ę‚Ä‚˘‚é3j8j12jB‘Α¤‚ÉŒ’ít‚đ—L‚ˇ‚éę‡‚É‚¨‚˘‚Ä‚ŕCŽîᇌa‚PcmˆČ‰ş‚Ě’P”­ŽîᇂŁClow gradeClow stage ‚Ɛf’f‚ł‚ę‚˝Ç—á‚ɑ΂ľ‚ẮC\•Ş‚ČŒoŒą‚đ—L‚ˇ‚鎥—Ăˆă‚Ě‚ŕ‚Ɛt‰ˇ‘śŽčp‚đl—ś‚ľ‚Ä‚ŕ‚悢B

t“ŕŽ‹‹žŽĄ—ĂŒă‚ĚŒo‰ßŠĎŽ@‚ĚƒvƒƒgƒR[ƒ‹‚Ĺ“ˆę‚ł‚ę‚˝‚ŕ‚Ě‚Í‚Č‚˘‚ށCˆČă‚̂悤‚ČÄ”­—Ś‚̍‚‚ł‚đl—ś‚ˇ‚é‚ƁC‚Rƒ•ŒŽŒăC‚Uƒ•ŒŽŒăCˆČŒă‚Q”NŠÔ‚Í‚Uƒ•ŒŽ‚˛‚ƁC‚ť‚ĚŒă‚Í‚P”N‚˛‚Ć‚É”A×–EfCäNă÷‹žC”AŠÇ‹ž‚ĚŒŸ¸‚đ­‚Č‚­‚Ć‚ŕ‚T”NŠÔŒp‘ą‚ˇ‚é‚ą‚Ć‚Ş„§‚ł‚ę‚é13jB‚Ü‚˝CT urography ‚đ‚Rƒ•ŒŽŒăC‚Uƒ•ŒŽŒăC‚P”NŒăC‚ť‚ĚŒă‚P”N‚˛‚Ć‚ÉŽ{s‚ˇ‚é‚ą‚Ć‚Ş„§‚ł‚ę‚éB‚ł‚ç‚ɏpŒă‚ĚŒľŠi‚ČŒo‰ßŠĎŽ@‚Ş•K—v‚Ĺ‚ ‚é‚ą‚Ć‚đC\•Ş‚ɏp‘O‚ć‚芳ŽŇ‚Éŕ–ž‚ľ‚Ä‚¨‚­•K—v‚Ş‚ ‚éB

tŒo‰ßŠĎŽ@’†CŽîᇂ̕aŠúi“W“™‚É‚ć‚čt”AŠÇ‘S“EœpEäNă÷•”•ŞŘœp‚ÉŽŠ‚éę‡‚ŕ‚ ‚é‚ŞC‚T”Nt‰ˇ‘ś—Ś‚Ígrade1 ŽîᇂĹ96%‚Ĺ‚ ‚é‚̂ɑ΂ľ‚āCgrade3 ŽîᇂłÍ20%‚Ćhigh grade ‚̐tṁE”AŠÇŠŕ‚ł͐t‰ˇ‘ś—Ś‚Í—LˆÓ‚ɒቺ‚ˇ‚é6jB‚Ü‚˝‚T”NŠŕ“ÁˆŮ“Iś‘ś—Ś‚ŕlow grade ŽîᇂŞ81~100%‚Ĺ‚ ‚é‚̂ɑ΂ľ‚āChigh grade ŽîᇂłÍ69~86%‚Ć—\Œă•s—Ç‚Ĺ‚ ‚é4j7j14jB

ŽĄ—ĂŒă‚Ěadjuvant ŽĄ—Ă‚Ć‚ľ‚Ämitomycin C15j‚âBCG16j‚Ěă•””A˜H’“ü—Ă–@‚ĚŽĄ—ÐŹŃ‚Ě•ń‚ŞŽUŒŠ‚ł‚ę‚é‚ŞC–ž‚ç‚Š‚ČÄ”­—\–hŒř‰Ę‚ĚŠmŘ‚Í“ž‚ç‚ę‚Ä‚˘‚Č‚˘B

ŽQl•śŒŁ

1j Martínez-Piñeiro JA, García Matres MJ, Martínez-Piñeiro L. Endourological treatment of upper tract urothelial carcinomas: analysis of a series of 59 tumors. J Urol. 1996; 156: 377-85.

2j Deligne E, Colombel M, Badet L, et al. Conservative management of upper urinary tract tumors. Eur Urol. 2002; 42: 43-8.

3j Thompson RH, Krambeck AE, Lohse CM, Elliott DS, Patterson DE, Blute ML. Endoscopic management of upper tract transitional cell carcinoma in patients with normal contralateral kidneys. Urology. 2008; 71: 713-7.

4j Lucas SM, Svatek RS, Olgin G, et al. Conservative management in selected patients with upper tract urothelial carcinoma compares favourably with early radical surgery. BJU Int. 2008; 102: 172-6.

5j Pak RW, Moskowitz EJ, Bagley DH. What is the cost of maintaining a kidney in upper-tract transitional-cell carcinoma? An objective analysis of cost and survival. J Endourol. 2009; 23: 341-6.

6j Cutress ML, Stewart GD, Wells-Cole S, Phipps S, Thomas BG, Tolley DA. Long-term endoscopic management of upper tract urothelial carcinoma: 20-year single-centre experience. BJU Int. 2012; 110: 1608-17.

7j Gadzinski AJ, Roberts WW, Faerber GJ, Wolf JS Jr. Long-term outcomes of nephroureterectomy versus endoscopic management for upper tract urothelial carcinoma. J Urol. 2010; 183: 2148-53.

8j Thompson RH, Krambeck AE, Lohse CM, Elliott DS, Patterson DE, Blute ML. Elective endoscopic management of transitional cell carcinoma first diagnosed in the upper urinary tract. BJU Int. 2008; 102: 1107-10.

9j Iborra I, Solsona E, Casanova J, Ricos JV, Rubio J, Climent MA. Conservative elective treatment of upper urinary tract tumors: a multivariate analysis of prognostic factors for recurrence and progression. J Urol. 2003; 169: 82-5.

10j Suh RS, Faerber GJ, Wolf JS Jr. Predictive factors for applicability and success with endoscopic treatment of upper tract urothelial carcinoma. J Urol. 2003; 170: 2209-16.

11j Keeley FX Jr., Bibbo M, Bagley DH. Ureteroscopic treatment and surveillance of upper urinary tract transitional cell carcinoma. J Urol. 1997; 157: 1560-5.

12j Krambeck AE, Thompson RH, Lohse CM, Patterson DE, Elliott DS, Blute ML. Imperative indications for conservative management of upper tract transitional cell carcinoma. J Urol. 2007; 178: 792-6.

13j Rouprêt M, Babjuk M, Compérat E, et al. European guidelines on upper tract urothelial carcinomas: 2013 update. Eur Urol. 2013; 63: 1059-71.

14j Rouprêt M, Hupertan V, Traxer O, et al. Comparison of open nephroureterectomy and ureteroscopic and percutaneous management of upper urinary tract transitional cell carcinoma. Urology. 2006; 67: 1181-7.

15j Cornu JN, Rouprêt M, Carpentier X, et al. Oncologic control obtained after exclusive flexible ureteroscopic management of upper urinary tract urothelial cell carcinoma. World J Urol. 2010; 28: 151-6.

16j Rastinehad AR, Ost MC, Vanderbrink BA, et al. A 20-year experience with percutaneous resection of upper tract transitional carcinoma: is there an oncologic benefit with adjuvant bacillus Calmette Guérin therapy? Urology. 2009; 73: 27-31.


Ⅳ ‘Sg‰ťŠw—Ă–@E‚ť‚Ě‘ź

‘ ˜_

Ⅰ “]ˆÚŤ‚ ‚邢‚͍Ĕ­Ť‚̐tṁE”AŠÇŠŕ‚ɑ΂ˇ‚é‘Sg‰ťŠw—Ă–@

“]ˆÚŤ‚ ‚邢‚͍Ĕ­Ť‚ĚäNă÷Šŕ‚ɑ΂ľ‚ẮCGC—Ă–@igemcitabineCcisplatinj‚âMVAC —Ă–@imethotrexateCvinblastineCdoxorubicinCcisplatinj‚Ş‰ČŠw“IŞ‹’‚Ě‚ ‚é‘Sg‰ťŠw—Ă–@‚ĚƒŒƒWƒƒ“‚Ć‚ľ‚ÄŽ{s‚ł‚ę‚Ä‚¨‚či•\jC‚˘‚¸‚ę‚ŕäNă÷Šŕf—ĂƒKƒCƒhƒ‰ƒCƒ“2009 ”N“x”łł͐„§ƒOƒŒ[ƒhA ‚Ć‚ľ‚Đ„§‚ł‚ę‚Ä‚˘‚éBˆę•űC“]ˆÚŤ‚ ‚邢‚͍Ĕ­Ť‚̐tṁE”AŠÇŠŕ‚ÉŠÖ‚ľ‚Ă͉ťŠw—Ă–@‚Ě—LŒřŤ‚đŽŚ‚ľ‚˝‰ČŠw“IŞ‹’‚̍‚‚˘•ń‚Í‚Č‚­CÇ—á•ńCƒP[ƒXƒVƒŠ[ƒY‚¨‚ć‚яŹ‹K–Í‚ĚŒă‚ëŒü‚ŤŒ¤‹†‚ޏ­”‚ ‚é‚ɉ߂Ź‚Č‚˘1j|3jB“]ˆÚŤ‚ ‚邢‚͍Ĕ­Ť‚Ě”A˜Hă”çŠŕ‚đ‘ÎŰ‚Ć‚ľ‚˝–łěˆ×‰ť”äŠrŽŽŒą‚Í‘śÝ‚ˇ‚é‚ŞCäNă÷ŠŕÇ—á‚Ə­”‚̐tṁE”AŠÇŠŕÇ—á‚Ş‡‚í‚š‚ĉđÍ‚ł‚ę‚Ä‚¨‚čC—źŽŇ‚̐ŹŃ‚Ěˆá‚˘‚Í–žŠm‚É‚ł‚ę‚Ä‚˘‚Č‚˘B2013 ”N‚ĚEAU ‚âNCCN ƒKƒCƒhƒ‰ƒCƒ“‚ł́CäNă÷Šŕ‚Ć“Ż‚ś”A˜Hă”çŠŕ‚Ĺ‚ ‚é‚ą‚Ć‚đ—˜_“IŞ‹’‚Ć‚ľ‚āCäNă÷Šŕ‚Ć“Ż‚śƒŒƒWƒƒ“‚đtṁE”AŠÇŠŕ‚É“K‰ž‚ľ‚Ä‚˘‚é‚Ě‚ŞŒťó‚Ĺ‚ ‚éB‚ľ‚Š‚ľC“Ż‚ś”A˜Hă”çŠŕ‚Ĺ‚ ‚Á‚Ä‚ŕ“]ˆÚŤ‚ ‚邢‚͍Ĕ­Ť‚ĚäNă÷Šŕ‚ƐtṁE”AŠÇŠŕ‚̉ťŠw—Ă–@‚Ö‚ĚŠ´ŽóŤ‚Í“Ż—l‚Ć‚ÍŒŔ‚ç‚Č‚˘4jB‚Ü‚˝C“]ˆÚŤ‚ ‚邢‚͍Ĕ­Ť‚̐tṁE”AŠÇŠŕ‚Ě‘˝‚­‚ĚŠłŽŇ‚ł́Cćs‚ˇ‚ét”AŠÇ‘S“EœpEäNă÷•”•ŞŘœp‚É‚ć‚čt‹@”\‚Ş’á‰ş‚ľ‚Ä‚˘‚é‚˝‚ß5j6jCcisplatin ‚đŠÜ‚މťŠw—Ă–@‚đ—\’č‚ľ‚Ä‚ŕ–ňÜ“Š—^—Ę‚ĚŒ¸—Ę‚Ş•K—v‚Čę‡‚Ş‘˝‚­CäNă÷Šŕ‚Ć“Ż“™‚̉ťŠw—Ă–@‚Ě—LŒřŤ‚Ş“ž‚ç‚ę‚é‚Š‚Ç‚¤‚Š‚ŕ•s–ž‚Ĺ‚ ‚éBt‹@”\‚É–â‘č‚Ş‚ ‚é“]ˆÚŤ‚ ‚邢‚͍Ĕ­Ť‚̐tṁE”AŠÇŠŕÇ—á‚ɑ΂ľ‚ẮC“]ˆÚŤ‚ ‚邢‚͍Ĕ­Ť‚ĚäNă÷Šŕ‚Ěcisplatin gunfith Ç—á‚ɏ€‚ś‚Äcarboplatin ‚â”ńƒvƒ‰ƒ`ƒiťÜ‚ŞŽg—p‚ł‚ę‚Ä‚˘‚é‚ŞC‰ČŠw“IŞ‹’‚É–R‚ľ‚­ŒoŒą“IŽĄ—Ă‚Ěˆć‚đo‚Č‚˘B‚Ü‚˝CäNă÷Šŕ‚Ć“Ż—l‚ɁCtṁE”AŠÇŠŕ‚É‚¨‚˘‚Ä‚ŕ—LŒřŤ‚ŞŘ–ž‚ł‚ę‚˝‚QŽŸC‚RŽŸ‰ťŠw—Ă–@‚ĚƒŒƒWƒƒ“‚Í‚Č‚­CŠłŽŇ‚Ě‘Sgó‘ԂȂǂɉž‚ś‚ÄˆŮ‚Č‚éƒŒƒWƒƒ“‚đ‡ŽŸŽg—p‚ľ‚Ä‚˘‚é‚Ě‚ŞŒťó‚Ĺ‚ ‚éBt”AŠÇ‘S“EœpEäNă÷•”•ŞŘœpŒă‚ĚÄ”­E“]ˆÚ‚ɑ΂ľ‚āCMVAC —Ă–@‚âGC —Ă–@‚Ȃǂ̉ťŠw—Ă–@‚đŽ{s‚ľ‚˝tṁE”AŠÇŠŕ132 –ź‚Ě—\Œă‚đŒă‚ëŒü‚Ť‚ÉŒŸ“˘‚ľ‚˝Ĺ‹ß‚Ě–{–M‚É‚¨‚Ż‚é‘˝Ž{Ý‹¤“ŻŒ¤‹†‚É‚ć‚é‚ƁC‰ťŠw—Ă–@ŠJŽnŽž‚ĚPSi0~1 vs 2~4jCŠĚ“]ˆÚ‚Ě—L–ł‚¨‚ć‚ŃÄ”­E“]ˆÚ•”ˆĘ‚ĚŒÂ”i‚Pvs †‚Qj‚ށC‘˝•Ď—ʉđÍ‚É‚¨‚˘‚ÄŠŕ“ÁˆŮ“Iś‘ś—Ś‚Ć‘Sś‘ś—Ś‚Ě‘o•ű‚đ‹K’股‚é“Ć—§‚ľ‚˝ˆöŽq‚Ĺ‚ ‚Á‚˝7jB

•\@GC—Ă–@‚ĆMVAC—Ă–@‚ĚŽĄ—ĂƒŒƒWƒƒ“
ƒŒƒWƒƒ“ –ňÜ “Š—^—Ę Day 1 Day 2 Day 8 Day 15 Day 22
GC
GEM
1,000 mg/m2
›   › ›  
  CDDP 70 mg/m2   ›      
MVAC
MTX
30 mg/m2 ›     › ›
 
VLB
3mg/m2   ›   › ›
 
ADM
30 mg/m2   ›      
  CDDP 70 mg/m2   ›      

’jGCCMVAC ‚Ć‚ŕ‚É28 “ú‚˛‚Ć‚ÉŽ{s
GEMFgemcitabineCCDDPFcisplatinCMTXFmethotrexateC
VLBFvinblastineCADMFdoxorubicin

Ⅱ BCG‚ ‚邢‚͍RŠŕÜ‚Ěă•””A˜H’“ü—Ă–@

ŒŔ‹ÇŤtṁE”AŠÇŠŕ‚ɑ΂ˇ‚é•W€ŽĄ—Â͐t”AŠÇ‘S“EœpEäNă÷•”•ŞŘœp‚Ĺ‚ ‚é‚ŞCćq‚ľ‚˝‚悤‚ɐt“Eœ‚É‚ć‚ét‹@”\‚̒ቺ‚Í”đ‚Ż‚ç‚ę‚Č‚˘B‚ą‚Ě‚˝‚߁C’PtCt‹@”\’ቺC—ź‘¤Ť‚Ȃǂ̐tṁE”AŠÇ‚ĚŒ´”­ŤCIS Ç—á‚ɑ΂ľ‚ẮCt‹@”\‰ˇ‘ś‚đ–Ú“I‚ÉBCG ‚Ěă•””A˜H’“ü—Ă–@‚ލs‚í‚ęC63~100%‚Ě”A×–Ef‰AŤ—Ś‚ŞŽĄ—ÐŹŃ‚Ć‚ľ‚Ä•ń‚ł‚ę‚Ä‚˘‚é8jBă•””A˜H‚Ö‚ĚBCG ’“ü•ű–@‚́CŒo”ç“Itᑂđ‰î‚ľ‚ď‡sŤ‚É’“ü‚ˇ‚é•ű–@C”AŠÇƒJƒe[ƒeƒ‹‚đ—Ż’u‚ľ‚Ä‹tsŤ‚É’“ü‚ˇ‚é•ű–@Cdouble-J ƒXƒeƒ“ƒg‚đ—Ż’u‚ľ‚ÄäNă÷“ŕ‚É’“ü‚ˇ‚é•ű–@‚Ş‚ ‚é‚ŞCĹ“K‚Č•ű–@‚ÍŒˆ’č‚ł‚ę‚Ä‚˘‚Č‚˘B‚Ü‚˝CŹ‹K–Í‚ČŒă‚ëŒü‚ŤŒ¤‹†‚ľ‚Š‚Č‚˘‚˝‚ßBCG ‚Ě“Š—^—ʁC“Š—^”Z“xC“Š—^ŽžŠÔC“Š—^‰ń”‚Č‚Ç‚ÉŠÖ‚ľ‚Ä‚ŕŠm—§‚ł‚ę‚˝•ű–@‚Í‚Č‚˘B

TURBT Œă‚̏pŒă•â•—Ă–@‚Ć‚ľ‚Ä‚ĚRŠŕÜCBCG ‚ĚäNă÷“ŕ’“ü—Ă–@‚́C‚ť‚ę‚ź‚ęC’áE’†ƒŠƒXƒNC‚ƒŠƒXƒN‚Ě‹Ř‘w”ńZŤäNă÷Šŕ‚ĚÄ”­‚đ—LˆÓ‚É—}§‚ˇ‚é‚˝‚߁CäNă÷Šŕf—ĂƒKƒCƒhƒ‰ƒCƒ“2009 ”N“x”łł͐„§ƒOƒŒ[ƒhA‚Ć‚ľ‚Đ„§‚ł‚ę‚Ä‚˘‚éBˆę•űCtṁE”AŠÇŠŕ‚ÉŠÖ‚ľ‚ẮC“ŕŽ‹‹ž“IŘœŒă‚̍RŠŕÜ‚âBCG ‚Ěă•””A˜H’“ü—Ă–@‚É‚ć‚éÄ”­—\–hŒř‰Ę‚đŒŸ“˘‚ľ‚˝•ń‚͏­‚Č‚­C‚ť‚Ě—LŒřŤ‚ɂ‚˘‚Ä‚ĚŒ‹˜_‚͏o‚Ä‚˘‚Č‚˘9j|11jB

Ⅲ •úŽËü—Ă–@

tṁE”AŠÇŠŕ‚ɑ΂ˇ‚é•úŽËü—Ă–@‚Ě—LŒřŤ‚ÉŠÖ‚ľ‚ẮCt”AŠÇ‘S“EœpEäNă÷•”•ŞŘœp‚Ěadjuvant —Ă–@‚ÉŠÖ‚ˇ‚éŒă‚ëŒü‚Ť‚Ě•ń‚ޏ­”‚ ‚é‚Ě‚Ý‚Ĺ‚ ‚éBŽîᇏ°}Š‘ŽƒŠƒ“ƒpß‚Ö‚ĚpŒăĆŽË’P“ƁC‚ ‚邢‚́C•úŽËü—Ă–@‚Ćcisplatin ƒx[ƒX‚̉ťŠw—Ă–@‚Ě•š—p‚É‚ć‚čsurvival benefit ‚Ş“ž‚ç‚ę‚˝‚Ć‚ˇ‚é•ń‚Ć“ž‚ç‚ę‚Č‚Š‚Á‚˝‚Ć‚ˇ‚é•ń‚ލŹÝ‚ľ‚Ä‚¨‚čCŒ‹˜_‚͈ę’č‚ľ‚Ä‚˘‚Č‚˘12j|15jB

ŽQl•śŒŁ

1j ˆäěŠ˛•v, A–Ř“N—T, ă“cŒőF, ‘ź. isŤtṁE”AŠÇŠŕ‚ɑ΂ˇ‚éMethotrexateEVinblastineEAdriamycinECisplatin iM-VACj•š—p—Ă–@‚̐ŹŃ. Šŕ‚ƉťŠw—Ă–@. 1989; 16: 2577-82.

2j Lerner SE, Blute ML, Richardson RL, Zincke H. Platinum-based chemotherapy for advanced transitional cell carcinoma of the upper urinary tract. Mayo Clin Proc. 1996; 71: 945-50.

3j Tanji N, Ozawa A, Miura N, et al. Long-term results of combined chemotherapy with gemcitabine and cisplatin for metastatic urothelial carcinomas. Int J Clin Oncol. 2010; 15: 369-75.

4j Audenet F, Yates DR, Cussenot O, Roupret M. The role of chemotherapy in the treatment of urothelial cell carcinoma of the upper urinary tractiUUT-UCCj. Urol Oncol. 2013; 31: 407-13.

5j Lane BR, Smith AK, Larson BT, et al. Chronic kidney disease after nephroureterectomy for upper tract urothelial carcinoma and implications for the administration of perioperative chemotherapy. Cancer. 2010; 116: 2967-73.

6j Kaag MG, OfMalley RL, OfMalley P, et al. Changes in renal function following nephroureterectomy may affect the use of perioperative chemotherapy. Eur Urol. 2010; 58: 581-7.

7j Tanaka N, Kikuchi E, Kanao K, et al. Patient characteristics and outcomes in metastatic upper tract urothelial carcinoma after radical nephroureterectomy: the experience of Japanese multi-institutions. BJU Int. 2013; 112: E28-34.

8j Giannarini G, Kessler TM, Birkhäuser FD, Thalmann GN, Studer UE. Antegrade perfusion with bacillus Calmette-Guérin in patients with non-muscleinvasive urothelial carcinoma of the upper urinary tract: who may benefit? Eur Urol. 2011; 60: 955-60.

9j Rastinehad AR, Ost MC, Vanderbrink BA, et al. A 20-year experience with percutaneous resection of upper tract transitional carcinoma: is there an oncologic benefit with adjuvant bacillus Calmette Guérin therapy? Urology. 2009; 73: 27-31.

10j Martínez-Piñeiro JA, García Matres MJ, Martínez-Piñeiro L. Endourological treatment of upper tract urothelial carcinomas: analysis of a series of 59 tumors. J Urol. 1996; 156: 377-85.

11j Keeley FX Jr., Bagley DH. Adjuvant mitomycin C following endoscopic treatment of upper tract transitional cell carcinoma. J Urol. 1997; 158: 2074-7.

12j Hall MC, Womack JS, Roehrborn CG, Carmody T, Sagalowsky AI. Advanced transitional cell carcinoma of the upper urinary tract: patterns of failure, survival and impact of postoperative adjuvant radiotherapy. J Urol. 1998; 160: 703-6.

13j Maulard-Durdux C, Dufour B, Hennequin C, et al. Postoperative radiation therapy in 26 patients with invasive transitional cell carcinoma of the upper urinary tract: no impact on survival? J Urol. 1996; 155: 115-7.

14j Chen B, Zeng ZC, Wang GM, et al. Radiotherapy may improve overall survival of patients with T3/T4 transitional cell carcinoma of the renal pelvis or ureter and delay bladder tumour relapse. BMC Cancer. 2011; 11: 297.

15j Czito B, Zietman A, Kaufman D, Skowronski U, Shipley W. Adjuvant radiotherapy with and without concurrent chemotherapy for locally advanced transitional cell carcinoma of the renal pelvis and ureter. J Urol. 2004; 172: 1271-5.


CQ13
t‰ˇ‘śŽĄ—Ă‚Ć‚ľ‚ÄBCG ‚ ‚邢‚͍RŠŕÜă•””A˜H’“ü—Ă–@‚͐„§‚ł‚ę‚é‚Š?

Answer

tṁE”AŠÇ‚ĚŒ´”­ŤCIS Ç—á‚ɑ΂ľ‚āC‡sŤ‚Ü‚˝‚Í‹tsŤ‚ÉBCG ă•””A˜H’“ü—Ă–@‚đŽŔŽ{‚ˇ‚é‚ą‚Ć‚É‚ć‚č’ˇŠú‚̐t‰ˇ‘ś‚މ”\‚Ć‚Č‚éÇ—á‚Ş‚ ‚éB’Pt‚ ‚邢‚Í—ź‘¤ŤC‚Ü‚˝t‹@”\áŠQ‚ ‚邢‚ÍPS‚Ş•s—ǂȐtṁE”AŠÇ‚ĚŒ´”­ŤCIS Ç—á‚ɑ΂ľ‚Ă͍l—ś‚ł‚ę‚鎥—Ă‚Ĺ‚ ‚éi„§ƒOƒŒ[ƒhC1jB

‰đ ŕ

tṁE”AŠÇ‚ĚŒ´”­ŤCIS Ç—á‚đŠÜ‚ߐtṁE”AŠÇŠŕ‚ɑ΂ľ‚ẮCt”AŠÇ‘S“EœpEäNă÷•”•ŞŘœp‚Ş‚ ‚­‚Ü‚Ĺ•W€“IŽĄ—Ă‚Ĺ‚ ‚é‚ŞCĹ‹ß‚Ĺ‚Í’Pt‚ ‚邢‚Í—ź‘¤ŤC‚Ü‚˝t‹@”\áŠQ‚ ‚邢‚ÍPS ‚Ş•s—Ç‚ČÇ—á‚ɑ΂ľ‚ÄBCG ‚ ‚邢‚͍RŠŕÜ‚Ěă•””A˜H’“ü—Ă–@‚ŞŽŽ‚Ý‚ç‚ę‚Ä‚˘‚éB‚ľ‚Š‚ľCÇ—ᐔ‚̏­‚Č‚˘Œă‚ëŒü‚ŤŒ¤‹†‚Ě•ń‚Ş‚Ů‚Ć‚ń‚Ç‚Ĺ‚ ‚éB

BCG ‚ ‚邢‚͍RŠŕÜ‚Ěă•””A˜H‚Ö‚Ě’“ü•ű–@‚Ć‚ľ‚ẮCtᑑ˘ÝŒă‚ɏ‡sŤ‚É’“ü‚ˇ‚é•ű–@C”AŠÇƒJƒe[ƒeƒ‹‚đ‹tsŤ‚É—Ż’u‚ľC”AŠÇƒJƒe[ƒeƒ‹‚Š‚璍“üC‚Ü‚˝‚Ídouble-J ƒXƒeƒ“ƒg‚đ—Ż’u‚ľCVUR‚đ—˜—p‚ľ’“ü‚ˇ‚é•ű–@‚Ş‚ ‚é‚ŞC‚Ç‚Ě•ű–@‚ŞĹ“K‚Ĺ‚ ‚é‚Š‚đ”äŠr‚ľ‚˝•ń‚Í‚Č‚˘B‚Ü‚˝C“KŘ‚Č“Š—^ŽžŠÔC“Š—^”Z“xC“Š—^ŠÔŠu‚ɂ‚˘‚Ä‚ŕŒŸ“˘‚Í‚Č‚ł‚ę‚Ä‚˘‚Č‚˘B

Giannarini ‚ç‚Í42 —á‚̐tṁE”AŠÇ‚ĚŒ´”­ŤCISÇ—á‚ɑ΂ľ‚ÄŒo”ç“I‚ɐtᑂ𑢐݂ľCäNă÷’“ü‚ĹŽg—p‚ˇ‚éBCG ‚Ě‚R”{—Ę‚đ150ml ‚É—n‰đ‚ľ‚˝ă‚Ĺ‚QŽžŠÔ‚Š‚Ż‚Ä‚U‰ń’“ü‚ˇ‚郌ƒWƒƒ“‚ĚŽĄ—ÐŹŃ‚đ•ń‚ľ‚Ä‚˘‚é1jB•˝‹ĎŠĎŽ@ŠúŠÔ‚Í42 ƒ•ŒŽ‚ŁC40%‚ɍĔ­C5%‚É•aŠúi“W‚đ”F‚߁C‚T”NC10”N‚Ě”ńÄ”­—Ś‚Í‚ť‚ę‚ź‚ę57%C49%‚Ĺ‚ ‚Á‚˝B‚ą‚ę‚ɑ΂ľ‚Ä“ŕŽ‹‹ž“IŽĄ—ĂŒă‚̏pŒă•â•—Ă–@‚Ć‚ľ‚ÄBCG ă•””A˜H’“ü‚đŽ{s‚ľ‚˝Ta/T1 Ç—ái22 —áj‚ł́C59%‚ɍĔ­C41%‚É•aŠúi“W‚đ”F‚߁CtṁE”AŠÇ‚ĚŒ´”­ŤCIS Ç—á‚ɑ΂ˇ‚鎥—ÐŹŃ‚É”ä‚×—\Œă•s—Ç‚Ĺ‚ ‚Á‚˝B

Double-J ƒXƒeƒ“ƒg‚Ü‚˝‚Í”AŠÇƒJƒe[ƒeƒ‹‚É‚ć‚é‹tsŤ’“ü‚É‚¨‚˘‚Ä‚ŕC63~100%‚Ě”A×–Ef‰AŤ—Ś‚Ş•ń‚ł‚ę‚Ä‚˘‚é2j|6jBKojima ‚ç‚Í11 —á‚̐tṁE”AŠÇ‚ĚŒ´”­ŤCIS Ç—á‚ɑ΂ľ‚āCdouble-J ƒXƒeƒ“ƒg—Ż’uŒă‚É’Ęí—Ę‚ĚBCG ‚đ40ml ‚É—n‰đ‚ľäNă÷’“ü‚ľ‚˝Œ‹‰Ę‚đ•ń‚ľ‚Ä‚˘‚é7jB‚X—ái82%j‚ĚÇ—á‚Ĺ”A×–Ef‚͉AŤ‰ť‚ľC‚T”N”ńÄ”­—Ś‚Í78%C‚T”NŠŕ“ÁˆŮ“Iś‘ś—Ś‚Í80%‚Ĺ‚ ‚čCt”AŠÇ‘S“EœpEäNă÷•”•ŞŘœpŒQi‚T”N”ńÄ”­—ŚF67%C‚T”NŠŕ“ÁˆŮ“Iś‘ś—ŚF91%j‚Ć”äŠr‚ľˇ‚đ”F‚ß‚Č‚Š‚Á‚˝‚Ć•ń‚ľ‚Ä‚˘‚éB

Rastinehad ‚ç‚́CtṁE”AŠÇŠŕ‚đ“ŕŽ‹‹ž“I‚ɐ؏œ‚ľ‚˝Œă‚ɏpŒă•â•—Ă–@‚Ć‚ľ‚ÄBCG ‚đtᑂć‚č‡sŤ‚É’“ü‚ľ‚˝ŒQ‚Ć’“ü—Ă–@–˘Ž{sŒQ‚đŒă‚ëŒü‚Ť‚É”äŠr‚ľCÄ”­E•aŠúi“W—Ś‚ɍˇ‚đ”F‚ß‚Č‚Š‚Á‚˝‚Ć•ń‚ľ‚Ä‚˘‚é8jB“ŕŽ‹‹ž“IŽĄ—ĂŒă‚̏pŒă•â•—Ă–@‚Ć‚ľ‚Ä‚ĚRŠŕÜă•””A˜H’“ü—Ă–@‚ł́Cmitomycin C ‚Ü‚˝‚Íadriamycin ‚Č‚Ç‚Ş—p‚˘‚ç‚ę‚Ä‚˘‚é‚ŞC‚Ç‚Ě•ń‚ŕÇ—ᐔ‚ޏ­‚Č‚­CÄ”­—\–h‚ɑ΂ľ‚Ä‚Ě—LŒřŤ‚Í–ž‚ç‚Š‚Ĺ‚Í‚Č‚˘9j10jB

ŽQl•śŒŁ

1j Giannarini G, Kessler TM, Birkhäuser FD, Thalmann GN, Studer UE. Antegrade perfusion with bacillus Calmette-Guérin in patients with non-muscleinvasive urothelial carcinoma of the upper urinary tract: who may benefit? Eur Urol. 2011; 60: 955-60.

2j Sharpe JR, Duffy G, Chin JL. Intrarenal bacillus Calmette-Guérin therapy for upper urinary tract carcinoma in situ. J Urol. 1993; 149: 457-9.

3j Nishino Y, Yamamoto N, Komeda H, Takahashi Y, Deguchi T. Bacillus Calmette-Guérin instillation treatment for carcinoma in situ of the upper urinary tract. BJU Int. 2000; 85: 799-801.

4j Nonomura N, Ono Y, Nozawa M, et al. Bacillus Calmette-Guérin perfusion therapy for the treatment of transitional cell carcinoma in situ of the upper urinary tract. Eur Urol. 2000; 38: 701-4.

5j Okubo K, Ichioka K, Terada N, Matsuta Y, Yoshimura K, Arai Y. Intrarenal bacillus Calmette-Guérin therapy for carcinoma in situ of the upper urinary tract: long-term follow-up and natural course in cases of failure. BJU Int. 2001; 88: 343-7.

6j Irie A, Iwamura M, Kadowaki K, Ohkawa A, Uchida T, Baba S. Intravesical instillation of bacille Calmette-Guérin for carcinoma in situ of the urothelium involving the upper urinary tract using vesicoureteral reflux created by a double-pigtail catheter. Urology. 2002; 59: 53-7.

7j Kojima Y, Tozawa K, Kawai N, Sasaki S, Hayashi Y, Kohri K. Long-term outcome of upper urinary tract carcinoma in situ: effectiveness of nephroureterectomy versus bacillus Calmette-Guérin therapy. Int J Urol. 2006; 13: 340-4.

8j Rastinehad AR, Ost MC, Vanderbrink BA, et al. A 20-year experience with percutaneous resection of upper tract transitional carcinoma: is there an oncologic benefit with adjuvant bacillus Calmette Guérin therapy? Urology. 2009; 73: 27-31.

9j Martínez-Piñeiro JA, García Matres MJ, Martínez-Piñeiro L. Endourological treatment of upper tract urothelial carcinomas: analysis of a series of 59 tumors. J Urol. 1996; 156: 377-85.

10j Keeley FX Jr., Bagley DH. Adjuvant mitomycin C following endoscopic treatment of upper tract transitional cell carcinoma. J Urol. 1997; 158: 2074-7.


CQ14
“]ˆÚŤ‚ ‚邢‚͍Ĕ­Ť‚̐tṁE”AŠÇŠŕ‚ɑ΂ˇ‚鉝Šw—Ă–@‚ɂ͂ǂ̂悤‚Č‚ŕ‚Ě‚Ş‚ ‚é‚Š?

Answer

“]ˆÚŤ‚ ‚邢‚͍Ĕ­Ťi‹ÇŠÄ”­j‚̐tṁE”AŠÇŠŕ‚ɑ΂ˇ‚鉝Šw—Ă–@‚́C“]ˆÚŤ‚ ‚邢‚͍Ĕ­Ť‚ĚäNă÷Šŕ‚Ć“Ż—l‚ÉGC —Ă–@‚âMVAC —Ă–@‚Č‚Ç‚Şs‚í‚ę‚éi„§ƒOƒŒ[ƒhBjB

‰đ ŕ

“]ˆÚŤ‚ ‚邢‚͍Ĕ­Ť‚ĚäNă÷Šŕ‚ɑ΂ľ‚ẮCGC —Ă–@igemcitabine, cisplatinj‚âMVAC —Ă–@imethotrexate, vinblastine, doxorubicin, cisplatinj‚Ş‰ČŠw“IŞ‹’‚Ě‚ ‚郌ƒWƒƒ“‚Ć‚ľ‚ÄŽ{s‚ł‚ę‚Ä‚¨‚čC‚˘‚¸‚ę‚ŕäNă÷Šŕf—ĂƒKƒCƒhƒ‰ƒCƒ“2009 ”N“x”łł͐„§ƒOƒŒ[ƒhA ‚Ć‚ľ‚Đ„§‚ł‚ę‚Ä‚˘‚éBˆę•űC“]ˆÚŤ‚ ‚邢‚͍Ĕ­Ť‚̐tṁE”AŠÇŠŕ‚ÉŠÖ‚ľ‚Ă͉ťŠw—Ă–@‚Ě—LŒřŤ‚đŽŚ‚ľ‚˝‰ČŠw“IŞ‹’‚̍‚‚˘•ń‚Í‚Č‚­C2013 ”N‚ĚEAU ‚âNCCN ƒKƒCƒhƒ‰ƒCƒ“‚ł́CäNă÷Šŕ‚Ć“Ż‚ś”A˜Hă”çŠŕ‚Ĺ‚ ‚é‚ą‚Ć‚đŞ‹’‚ɁCäNă÷Šŕ‚Ć“Ż‚śƒŒƒWƒƒ“‚đ“K‰ž‚ľ‚Ä‚˘‚é‚Ě‚ŞŒťó‚Ĺ‚ ‚éB‚ľ‚Š‚ľC“Ż‚ś”A˜Hă”çŠŕ‚Ĺ‚ ‚Á‚Ä‚ŕ“]ˆÚŤ‚ ‚邢‚͍Ĕ­Ť‚ĚäNă÷Šŕ‚ƐtṁE”AŠÇŠŕ‚̉ťŠw—Ă–@‚Ö‚ĚŠ´ŽóŤ‚Í“Ż—l‚Ć‚ÍŒŔ‚炸1jC‚Ü‚˝C“]ˆÚŤ‚ ‚邢‚͍Ĕ­Ť‚̐tṁE”AŠÇŠŕ‚Ě‘˝‚­‚ĚŠłŽŇ‚ł͐ćs‚ˇ‚ét”AŠÇ‘S“EœpEäNă÷•”•ŞŘœp‚É‚ć‚čt‹@”\‚Ş’á‰ş‚ľ‚Ä‚˘‚é‚˝‚ß2jCcisplatin ‚đŠÜ‚މťŠw—Ă–@‚đ—\’č‚ľ‚Ä‚ŕ–ňÜ“Š—^—Ę‚ĚŒ¸—Ę‚Ş•K—v‚Čę‡‚Ş‘˝‚­CäNă÷Šŕ‚Ć“Ż“™‚̉ťŠw—Ă–@‚Ě—LŒřŤ‚Ş“ž‚ç‚ę‚é‚Š‚Ç‚¤‚Š‚Í–ž‚ç‚Š‚Ĺ‚Í‚Č‚˘B‚Ü‚˝CäNă÷Šŕ‚Ć“Ż—l‚ɁCtṁE”AŠÇŠŕ‚É‚¨‚˘‚Ä‚ŕ—LŒřŤ‚ŞŘ–ž‚ł‚ę‚˝‚QŽŸC‚RŽŸ‰ťŠw—Ă–@‚ĚƒŒƒWƒƒ“‚Í‘śÝ‚ľ‚Č‚˘B

“]ˆÚŤ‚ ‚邢‚͍Ĕ­Ť‚̐tṁE”AŠÇŠŕŠłŽŇ‚đ‘ÎŰ‚É‰ťŠw—Ă–@‚ĚŒř‰Ę‚đŒŸ“˘‚ľWĎ‚ľ‚˝•ń‚͋ɂ߂ď­‚Č‚˘Bˆäě‚ç‚́CisŤtṁE”AŠÇŠŕ17 —áip‘O‰ťŠw—Ă–@‚S—á‚đŠÜ‚ށj‚đ‘ÎŰ‚É•˝‹Ď2.6 ƒR[ƒX‚ĚMVAC —Ă–@‚đŽ{s‚ľ‚˝Œ‹‰ĘC‘tŒř—ŚiCR+PRj‚Ş‚X—ái52.9%j‚Ĺ‚ ‚Á‚˝‚Ć•ń‚ľ‚Ä‚˘‚é3jB‘ŸŠí•Ę‚Ě‘tŒř—Ś‚́CŒ´”­‘ƒ62.5%CƒŠƒ“ƒpß54.5%C”x66.7%CŠĚ0%Cœ40%‚Ĺ‚ ‚Á‚˝B13 —á‚Ĺ‚Í–ňÜ“Š—^—Ę‚ĚŒ¸—Ę‚â15 “ú–ځC22 “ú–Ú‚Ĺ‚Ě–ňÜ“Š—^‚Ě’†Ž~‚Ş•K—v‚Ĺ‚ ‚Á‚˝B28 —á‚̐isŤtṁE”AŠÇŠŕ‚ɑ΂ľ‚Äcisplatin ‚đŠÜ‚މťŠw—Ă–@‚ĚŒř‰Ę‚đŒŸ“˘‚ľ‚˝Lerner ‚ç‚Ě•ń‚ł́C‘tŒř—Ś‚Í54%‚Ĺ‚ ‚Á‚˝‚ŞCR ‚͏­”‚Ĺ‚ ‚čC’ˇŠúś‘ś—á‚ŕ­‚Č‚Š‚Á‚˝4jB‚Ü‚˝C79%‚ł͐t‹@”\’ቺ‚Ě‚˝‚ß‚É–ňÜ“Š—^—Ę‚ŞŒ¸—Ę‚ł‚ę‚˝BTanji ‚ç‚́CtṁE”AŠÇŠŕ‚đŠÜ‚Ţ71 —á‚Ě“]ˆÚŤ”A˜Hă”çŠŕ‚ɑ΂ˇ‚éĹ’á‚QƒR[ƒX‚ĚGC —Ă–@‚ĚŽĄ—ÐŹŃ‚đ•ń‚ľ‚Ä‚˘‚é5jB‰ťŠw—Ă–@–˘Ž{s—á‚ ‚邢‚́C‰ťŠw—Ă–@I—šŒă‚Uƒ•ŒŽˆČŒă‚ɍĔ­‚đŽŚ‚ľ‚˝Ç—á‚É‚¨‚Ż‚é‘tŒř—Ś‚́Ct᱊ŕ35%i6/17jC”AŠÇŠŕ43%i9/21jCäNă÷Šŕ50%i16/32j‚ƍˇ‚đ”F‚ß‚¸C–ł‘ˆŤś‘śŠúŠÔ‚É‚¨‚˘‚Ä‚ŕ—LˆÓˇ‚Í”F‚ß‚Č‚Š‚Á‚˝‚Ć‚ľ‚Ä‚˘‚éB

ŽQl•śŒŁ

1j Audenet F, Yates DR, Cussenot O, Rouprêt M. The role of chemotherapy in the treatment of urothelial cell carcinoma of the upper urinary tractiUUT-UCCj. Urol Oncol. 2013; 31: 407-13.

2j Lane BR, Smith AK, Larson BT, et al. Chronic kidney disease after nephroureterectomy for upper tract urothelial carcinoma and implications for the administration of perioperative chemotherapy. Cancer. 2010; 116: 2967-73.

3j ˆäěŠ˛•v, A–Ř“N—T, ă“cŒőF, ‘ź. isŤtṁE”AŠÇŠŕ‚ɑ΂ˇ‚éMethotrexateEVinblastineEAdriamycinECisplatin iM-VACj•š—p—Ă–@‚̐ŹŃ. Šŕ‚ƉťŠw—Ă–@. 1989; 16: 2577-82.

4j Lerner SE, Blute ML, Richardson RL, Zincke H. Platinum-based chemotherapy for advanced transitional cell carcinoma of the upper urinary tract. Mayo Clin Proc. 1996; 71: 945-50.

5j Tanji N, Ozawa A, Miura N, et al. Long-term results of combined chemotherapy with gemcitabine and cisplatin for metastatic urothelial carcinomas. Int J Clin Oncol. 2010; 15: 369-75.


CQ15
t‹@”\áŠQŽž‚̉ťŠw—Ă–@‚ɂ͂ǂ̂悤‚Č‚ŕ‚Ě‚Ş‚ ‚é‚Š?

Answer

tṁE”AŠÇŠŕ‚̐t‹@”\áŠQÇ—á‚ɑ΂ˇ‚é’č‚Ü‚Á‚˝‰ťŠw—Ă–@‚ĚƒŒƒWƒƒ“‚Í‘śÝ‚ľ‚Č‚˘Bt”AŠÇ‘S“EœpEäNă÷•”•ŞŘœpŒă‚Í‚ł‚ç‚ɐt‹@”\‚Ş’á‰ş‚ˇ‚é‚˝‚߁Ct‹@”\‚Ě–Ę‚đl—ś‚ˇ‚é‚Ě‚Ĺ‚ ‚ę‚Îcisplatin ƒx[ƒX‚ĚŽüpŠú•â•‰ťŠw—Ă–@‚Íneoadjuvant ‚Ć‚ľ‚ďp‘O‚ÉŽŔŽ{‚ˇ‚é‚Ů‚¤‚Ş–]‚Ü‚ľ‚˘i„§ƒOƒŒ[ƒhC1jB

‰đ ŕ

tṁE”AŠÇŠŕ‚ÍäNă÷Šŕ‚Ć“Ż—l‚Écisplatin ƒx[ƒX‚̉ťŠw—Ă–@‚Ě—LŒřŤ‚ŞŠú‘Ň‚ł‚ę‚éB‚ľ‚Š‚ľt‹@”\áŠQ‚đ—L‚ˇ‚éÇ—á‚ɑ΂ľ‚ẮCƒvƒ‰ƒ`ƒiťÜ‚Ě—LŠQŽ–Ű‚Ě’†‚Ĺ‚ŕ“Á‚ɐt‹@”\áŠQ‚Ş‘ĺ‚Ť‚Č–â‘č‚Ć‚Č‚éBŒťŽž“_‚ŁCt‹@”\áŠQ‚ɑ΂ˇ‚é’č‚Ü‚Á‚˝‰ťŠw—Ă–@‚ĚƒŒƒWƒƒ“‚Í‘śÝ‚š‚¸Ccarboplatin ƒx[ƒXC”ńƒvƒ‰ƒ`ƒiťÜ“™‚ĚƒŒƒWƒƒ“‚Ş•ń‚ł‚ę‚Ä‚˘‚é‚ŞC‚ť‚Ě—LŒřŤ‚͏\•Ş‚ÉŒŸ“˘‚ł‚ę‚Ä‚˘‚Č‚˘B

tṁE”AŠÇŠŕ‚ÉŒŔ’č‚ľ‚ÄŽŔŽ{‚ł‚ę‚˝‘ĺ‹K–Í‚Č–łěˆ×‰ť”äŠrŽŽŒą‚Í‘śÝ‚š‚¸C‚Ů‚Ć‚ń‚Ç‚Ě•ń‚Ş”A˜Hă”çŠŕ‚Ć‚ľ‚ÄäNă÷Šŕ‚Ć‚Ć‚ŕ‚É“o˜^‚ľ‰đÍ‚ł‚ę‚˝‚ŕ‚Ě‚Ĺ‚ ‚éB“––Ę‚Í“]ˆÚŤäNă÷Šŕ‚ɏ€‚ś‚˝ŽĄ—Ă‚đŽQl‚É‚ľCt‹@”\áŠQ‚Ş‚ ‚éę‡‚É‚Í“]ˆÚŤäNă÷Šŕ‚Ěcisplatin gunfith Ç—á‚ɏ€‚ś‚˝‰ťŠw—Ă–@‚đŽg—p‚ˇ‚é‚ľ‚Š‚Č‚˘B‚ľ‚Š‚ľCäNă÷Šŕ‚ƐtṁE”AŠÇŠŕ‚ĚŽîᇊw“IŤŽż‚Í•K‚¸‚ľ‚ŕ“Żˆę‚Ĺ‚Í‚Č‚­CĄŒătṁE”AŠÇŠŕ‚É“Á‰ť‚ľ‚˝‰ťŠw—Ă–@‚ĚŠm—§‚Ş‹}–ą‚Ĺ‚ ‚éB

ŽüpŠú•â•‰ťŠw—Ă–@‚đŽ{s‚ˇ‚éę‡Ct”AŠÇ‘S“EœpEäNă÷•”•ŞŘœpŒă‚É‚ÍŠmŽŔ‚ɐt‹@”\‚Ş’á‰ş‚ˇ‚é‚̂ŁCpŒă•â•‰ťŠw—Ă–@‚Ě“K‰ž‚ÍŒŔ‚ç‚ę‚˝‚ŕ‚Ě‚É‚Č‚éBCleveland Clinic ‚ł́Ct”AŠÇ‘S“EœpEäNă÷•”•ŞŘœp‚đŽ{s‚ľ‚˝336 —á‚̐tṁE”AŠÇŠŕ‚đ‘ÎŰ‚ÉCp‘OŒă‚̐t‹@”\•]‰ż‚Ćcisplatin ƒx[ƒX‚̉ťŠw—Ă–@‚މ”\‚Ȑt‹@”\‚đ—L‚ˇ‚銳ŽŇ‚ĚŠ„‡‚đŒă‚ëŒü‚Ť‚ÉŒŸ“˘‚ľ‚Ä‚˘‚é1jBeGFR ‚Ş60ml/•Ş/1.73m2 –˘–ž‚đCKDichronic kidney diseasej‚Ć‚ľ‰ťŠw—Ă–@•s‰Â”\—á‚Ć’č‹`‚ˇ‚é‚ƁCp‘O‚Ĺ‚Í48%‚ĚŠłŽŇ‚މťŠw—Ă–@‰Â”\‚Ĺ‚ ‚Á‚˝‚ށCpŒă‚Í22%‚Ć—LˆÓ‚ɒቺ‚ľ‚˝BtṁE”AŠÇŠŕÇ—á‚ɑ΂ľ‚Äcisplatin ƒx[ƒX‚̉ťŠw—Ă–@‚đŽŔŽ{‚ˇ‚é‚Ě‚Ĺ‚ ‚ę‚΁Cp‘O‚Éneoadjuvant‚Ć‚ľ‚ÄŽŔŽ{‚ˇ‚ׂŤ‚Ĺ‚ ‚é‚Əq‚ׂâ‚éB“Ż—l‚Ě•ń‚ÍMemorial Sloan-Kettering Cancer Center ‚𒆐S‚Ć‚ˇ‚é‘˝Ž{Ý‹¤“ŻŒ¤‹†‚Š‚ç‚ŕ‚Č‚ł‚ę‚Ä‚˘‚é2jBt”AŠÇ‘S“EœpEäNă÷•”•ŞŘœp‚đs‚Á‚˝388 —á‚đ‘ÎŰ‚ÉŒă‚ëŒü‚Ť‚ÉŒŸ“˘‚ľ‚˝‚Ć‚ą‚ëCcisplatin ƒx[ƒX‚ĚŽüpŠú‰ťŠw—Ă–@‚މ”\‚ČÇ—á‚ĚŠ„‡‚́Cp‘O‚Ě49%‚Š‚çCpŒă‚Í19%‚ɒቺ‚ľ‚˝B70 ÎˆČă‚̍‚—îŽŇ‚Ĺ‚Í‚ł‚ç‚É‚ą‚ĚŒXŒü‚ÍŒ°’˜‚Ĺ‚ ‚Á‚˝B‚ą‚ĚŒ¤‹†‚É‚¨‚˘‚Ä‚ŕŽüpŠú‰ťŠw—Ă–@‚͏p‘O‚ɍs‚¤‚ׂŤ‚Ĺ‚ ‚é‚Əq‚ׂâ‚é‚ŞC‰ťŠw—Ă–@‚Ě‹ď‘Ě“I‚ČƒŒƒWƒƒ“‚ÍŒž‹y‚ł‚ę‚Ä‚˘‚Č‚˘B

t”AŠÇ‘S“EœpEäNă÷•”•ŞŘœp‚¨‚ć‚Ńcisplatin ƒx[ƒX‚Ěadjuvant ‰ťŠw—Ă–@‚đs‚˘Ct‹@”\‚đ•]‰ż‚ľ‚˝•ń‚͋ɂ߂ď­‚Č‚­3jC‹H‚ÉŒŒ‰t“§Í‚ÉŽŠ‚é—á‚Ş‚ ‚é‚ą‚Ć‚Ş•ń‚ł‚ę‚Ä‚˘‚éB

ŽQl•śŒŁ

1j Lane BR, Smith AK, Larson BT, et al. Chronic kidney disease after nephroureterectomy for upper tract urothelial carcinoma and implications for the administration of perioperative chemotherapy. Cancer. 2010; 116: 2967-73.

2j Kaag MG, OfMalley RL, OfMalley P, et al. Changes in renal function following nephroureterectomy may affect the use of perioperative chemotherapy. Eur Urol. 2010; 58: 581-7.

3j Cho KS, Joung JY, Seo HK, et al. Renal safety and efficacy of cisplatin-based chemotherapy in patients with a solitary kidney after nephroureterectomy for urothelial carcinoma of the upper urinary tract. Cancer Chemother Pharmacol. 2011; 67: 769-74.


CQ16
tṁE”AŠÇŠŕ‚É•úŽËü’P“ĆŽĄ—Ă‚Í—LŒř‚Š?

Answer

ŠO‰ČŽĄ—Ă–˘Ž{s—á‚̐tṁE”AŠÇŠŕ‚đ‘ÎŰ‚Ć‚ľ‚˝•úŽËüĆŽË’P“Ć‚ĚŽĄ—ÐŹŃ‚Ě•ń‚Í‘śÝ‚ľ‚Č‚˘B‚Ü‚˝pŒă’ljÁŽĄ—Ă‚Ć‚ľ‚Ä‚Ě•úŽËü—Ă–@‚Ě—L—pŤ‚ÉŠÖ‚ľ‚Ä‚ŕŹ‹K–Í‚ČŒă‚ëŒü‚ŤŒŸ“˘‚Ě‚Ý‘śÝ‚ľCŒťŽž“_‚Ĺ•úŽËüŽĄ—Ă‚Ě—LŒřŤ‚Í–ž‚ç‚Š‚Ć‚ł‚ę‚Ä‚˘‚Č‚˘i„§ƒOƒŒ[ƒhC2jB

‰đ ŕ

Hall ‚ç‚Í1960 ”N‚Š‚ç1992 ”N‚ÉTexas ‘ĺŠwSouthwestern Medical Center ‚ĹŽčp‚đs‚Á‚˝tṁE”AŠÇŠŕ252 —á‚đŒă‚ëŒü‚Ť‚ÉŒŸ“˘‚ľ‚˝1jBStage Ⅲ/Ⅳ‚Ě74 —á’†28 —á‚ɏpŒă•úŽËüŽĄ—Ă‚ŞŽŔŽ{‚ł‚ęCĆŽËŒQ28 —á’†‚R—ái11%jC”ńĆŽËŒQ46 —á’†‚V—ái15%j‚͏pŒă‚ÉMVAC —Ă–@imethotrexate, vinblastine, doxorubicin, cisplatinj‚ŞŽŔŽ{‚ł‚ę‚Ä‚˘‚˝BĆŽËü—Ę‚Ě’†‰›’l‚Í39.8Gy ‚Ĺ‚ ‚Á‚˝BStage Ⅲ/Ⅳ‚Ě74 —á‚Ě‚T”N‘Sś‘ś—Ś‚Í21%C‚T”NŠŕ“ÁˆŮ“Iś‘ś—Ś‚Í30%‚Ĺ‚ ‚Á‚˝BStage Ⅲ‚Ě‚T”NŠŕ“ÁˆŮ“Iś‘ś—Ś‚ÍĆŽËŒQ‚Ĺ45%C”ńĆŽËŒQ‚Ĺ40%‚Ć—LˆÓˇ‚Í‚Č‚­C‚Ü‚˝stage Ⅳ‚Ě•˝‹Ďś‘śŠúŠÔ‚ŕCĆŽËŒQ‚Ĺ‚Vƒ•ŒŽC”ńĆŽËŒQ‚Ĺ‚Xƒ•ŒŽ‚Ć—LˆÓˇ‚Í‚Č‚­CpŒă•úŽËü—Ă–@‚Í—LŒř‚Ĺ‚Í‚Č‚˘‚Əq‚ׂâ‚éBMaulard-Durdux ‚ç‚ÍŽčpŽĄ—Ă‚đs‚Á‚˝pT2/3 tṁE”AŠÇŠŕ26—á‚đ—p‚˘‚ďpŒă•úŽËü—Ă–@‚Ě—LŒřŤ‚đŒă‚ëŒü‚Ť‚ÉŒŸ“˘‚ľ‚˝2jBĆŽËü—Ę‚Ě•˝‹Ď’l‚Í45Gy ‚Ĺ‚ ‚Á‚˝B•˝‹ĎŠĎŽ@ŠúŠÔ45 ƒ•ŒŽ‚ŁCŠĎŽ@ŠúŠÔ’†‚ɋǏŠÄ”­‚Ş‚P—áCŠ‘ŽƒŠƒ“ƒpß“]ˆÚ‚Ş‚S—áC‰“Šu“]ˆÚ‚Ş14 —á‚É”F‚ß‚ç‚ę‚˝B‚T”N‘Sś‘ś—Ś‚Í49%‚Ĺ‚ ‚Á‚˝‚ށC“Ż—l‚Ě•a—•aŠúÇ—á‚đŽčp’P“Ć‚ĹŽĄ—Ă‚ľ‚˝‘ź‚Ě•ń‚ĚŽĄ—ÐŹŃ‚Ć”äŠr‚ľC–ž‚ç‚Š‚ȍˇ‚đ”F‚ß‚Č‚Š‚Á‚˝‚Ć•ń‚ľ‚Ä‚˘‚éB

ˆę•űCChen ‚ç‚Í1998 ”N‚Š‚ç2008 ”N‚ɐt”AŠÇ‘S“EœpEäNă÷•”•ŞŘœp‚đs‚Á‚˝133 —á‚đ‘ÎŰ‚ÉpŒă•úŽËüŽĄ—Ă‚Ě—L—pŤ‚đŒă‚ëŒü‚Ť‚ÉŒŸ“˘‚ľC‚ť‚ĚŽĄ—ĂŒř‰Ę‚̉”\Ť‚𮦍´‚ľ‚Ä‚˘‚é3jB‘SÇ—á’†67 —á‚ɏpŒă•úŽËüŽĄ—Ă‚ŞŽ{s‚ł‚ęC66 —á‚͏pŒăRŠŕÜäNă÷“ŕ’“ü—Ă–@‚Ě‚Ý‚ŞŽ{s‚ł‚ę‚˝BĆŽËü—Ę‚Ě’†‰›’l‚Í50Gy ‚Ĺ‚ ‚Á‚˝B‘SÇ—á‚đ‘ÎŰ‚Ć‚ˇ‚é‚Ć—źŒQŠÔ‚Ĺ‘Sś‘ś—Ś‚É—LˆÓˇ‚đ”F‚ß‚Č‚Š‚Á‚˝‚ށCpT3/4 ‚ĚŠłŽŇŒQ‚ÉŒŔ‚é‚Ć•úŽËüŽĄ—Ă‚É‚ć‚č—LˆÓ‚É‘Sś‘ś—Ś‚މ„’ˇ‚ľ‚˝B‘˝•Ď—ʉđÍ‚É‚¨‚˘‚āC•úŽËüŽĄ—ĂŽ{s‚Ě—L–ł‚Í“Ć—§‚ľ‚˝—\Œă—\‘ވöŽq‚Ĺ‚ ‚Á‚˝BCzito ‚ç‚ÍMassachusetts General Hospital ‚É‚¨‚˘‚Ä1970 ”N‚Š‚ç1997 ”N‚̊ԂɁC•úŽËüĆŽË‚đs‚Á‚˝“]ˆÚ‚đ—L‚ł‚Č‚˘tṁE”AŠÇŠŕ31 —á‚đ‘ÎŰ‚Ét”AŠÇ‘S“EœpEäNă÷•”•ŞŘœpŒă‚̏pŒă•úŽËü—Ă–@‚ƉťŠw—Ă–@•š—pŽĄ—Ă‚Ě—LŒřŤ‚đ•ń‚ľ‚Ä‚˘‚é4jB31 —á’†28 —ái90%j‚Ístage Ⅲ/Ⅳ‚ŁCĆŽËü—Ę‚Ě•˝‹Ď’l‚Í46.9Gy ‚Ĺ‚ ‚Á‚˝B‚Ü‚˝‚ą‚Ě‚¤‚ż‚X—á‚Écisplatin ƒx[ƒX‚Ě‘Sg‰ťŠw—Ă–@‚Ş•š—pŽĄ—Ă‚ł‚ę‚˝B‰ťŠw—Ă–@‚Ş•š—p‚ł‚ę‚˝•úŽËüŽĄ—ĂŒQ‚Ě‚T”N‘Sś‘ś—Ś‚Í67%‚ŁC•úŽËüŽĄ—Ă’P“ĆŒQi27%j‚Ć”äŠr‚ľ—LˆÓ‚ɍ‚‚Š‚Á‚˝B

ˆČă‚̂悤‚ɁCt”AŠÇ‘S“EœpEäNă÷•”•ŞŘœpŒă‚̏pŒă•úŽËü—Ă–@‚Ě—LŒřŤ‚ÉŠÖ‚ľ‚Ă͈ę’č‚ĚŒŠ‰đ‚Ş“ž‚ç‚ę‚Ä‚˘‚Č‚˘‚Ě‚ŞŒťó‚Ĺ‚ ‚éB

ŽQl•śŒŁ

1j Hall MC, Womack JS, Roehrborn CG, Carmody T, Sagalowsky AI. Advanced transitional cell carcinoma of the upper urinary tract: patterns of failure, survival and impact of postoperative adjuvant radiotherapy. J Urol. 1998; 160: 703-6.

2j Maulard-Durdux C, Dufour B, Hennequin C, et al. Postoperative radiation therapy in 26 patients with invasive transitional cell carcinoma of the upper urinary tract: no impact on survival? J Urol. 1996; 155: 115-7.

3j Chen B, Zeng ZC, Wang GM, et al. Radiotherapy may improve overall survival of patients with T3/T4 transitional cell carcinoma of the renal pelvis or ureter and delay bladder tumour relapse. BMC Cancer. 2011; 11: 297.

4j Czito B, Zietman A, Kaufman D, Skowronski U, Shipley W. Adjuvant radiotherapy with and without concurrent chemotherapy for locally advanced transitional cell carcinoma of the renal pelvis and ureter. J Urol. 2004; 172: 1271-5.