Lactate dehydrogenase is a prognostic indicator for prostate cancer patients with bone metastasis

Abstract

We analyzed clinical data to identify prognostic indicators in prostate cancer patients with bone metastasis. The subjects were 60 patients with bone metastasis out of 165 patients diagnosed with prostate cancer at our clinic over 6 years from January 1998 to December 2003. The age at the initial diagnosis was 61 to 91 (mean: 73.7 +/- 7.5) years old. The following items were considered to be possible prognostic indicators: T (type) classification, N (node) classification, Gleason score, prostate specific antigen (PSA) value before therapy, disease grade, alkaline phosphatase (ALP), lactate dehydrogenase (LDH), serum calcium (Ca), hemoglobin (Hgb), and platelet count (Plt). The 5-year overall survival rate was 45.7% in the 60 patients. Univariate analysis showed statistically significant differences in N (1), Gleason score 7 + 8/Gleason score 9 + 10, and LDH level (p = 0.0053, 0.0261, and 0.0049, respectively). Multivariate Cox proportional hazard analysis of these three items showed a statistically significant difference in LDH level and Gleason score 9 +/- 10 (p = 0.0167 and 0.0371). LDH was suggested to be an excellent prognostic indicator, because of its objectivity and convenience of measurement, in prostate cancer patients with bone metastasis.

目的:どのような前立腺癌骨転移症例が内分泌療法抵抗性へと移行し, 予後不良な転帰をたどるのであるか, 詳細は明らかにされていない。今回, われわれは前立腺癌骨転移症例に対し, 各種臨床データにおける予後予測因子としての可能性を検討した。対象と方法:1998年1月から2003年12月までの6年間に当院において前立腺癌と診断された165例中, 骨転移を有する60例を対象とした。初診時年齢は61～91歳(平均73.7±7.5歳)であった。検討項目としては, T classification, N classification, Gleason score(GS), 治療前prostate specific antigen(PSA)値, extent of disease grade, alkaline phosphatase(ALP), lactate dehydrogenase(LDH), 血清calcium(Ca), hemoglobin(Hgb), platelet(Plt)とした。結果:60例の5-year overall survival rateは45.7%であった。単変量解析にて統計学的に有意差が認められた項目は, N(1), GS7+8とGS9+10, LDH異常値であった(p=0.0053, p=0.0261, p=0.0049)。これら3群のmultivariate Cox proportional hazard analysisではLDH異常値とGS9+10で統計学的有意差が認められた(p=0.0167, p=0.0371)。結論:LDHは, その客観性および簡便性から, 前立腺癌骨転移症例に対し有力な予後予測因子であると考えられた。(著者抄録)