前立腺癌の臨床的検討 : 当科における最近21年間184例の成績

Abstract

1)初診時年齢は平均71.8歳で, 70歳代が最多で51%, 以降60歳代, 80歳代の順であった. 2)stage別の割合ではC以上で全体の85%を占めた.組織学的には中分化型, 低分化型, 高分化型の順であった. 3)治療法別生存率では根治的全摘群の5年生存率が82.1%と予後が良好な傾向にあった.DESP単独治療群とDESP投与に去勢術を加えた群では, 後者の生存率が良好な傾向を示したが, 統計学的有意差はなかった. 4)stage別生存率ではC, Dの間で5年以内の生存率で統計学的有意差を認めた.組織学的異型度別では高分化程生存率が良好な傾向を示した

One hundred and eighty-four patients with prostatic cancer were treated at Mie University Hospital from 1973 to 1993. They were between 47 and 90 years old, with an average age of 71.8 years old. One hundred and fifty-eight patients (85.8%) were in either stage C or D. Of the 146 cases histologically examined, 17.8% were well differentiated adenocarcinoma, and 47.9% and 34.2% were moderately and poorly differentiated adenocarcinomas, respectively. The overall 3-year, 5-year and 10-year survival rate were 64.2%, 44.9% and 24.2%, respectively. The patients with high stage and/or poorly differentiated adenocarcinomas revealed worse prognosis. Although the prognosis in the patients treated with estrogen and orchiectomy was better than that with estrogen alone, there was no significant difference between the 2 treatment groups. The prognosis of patients with prostatic cancer has been improved since 1988. A possible explanation is that prostate specific antigen has been introduced as a tumor marker, which might contribute to an accurate diagnosis in prostatic cancer and improve the prognosis of the disease. In conclusion, the diagnosis in lower stage and radical prostatectomy might bring favorable prognosis. In future, safer and more effective chemotherapy and endocrine therapy including LH-RH analogue are awaited, to obtain a better prognosis in the patients with advanced prostatic cancer.