前立腺癌の臨床的検討 ―当科における最近12年間107例の成績―

Abstract

筆者らの施設において過去11年間に治療した新鮮前立腺癌107症例について検討した.初診時年齢は53～89歳に分布し, 平均70.8±8.0歳で, 年齢分布は50歳代7例, 60歳代40例, 70歳代43例, 80歳代17例であった.初診時のstageは, stage A 3例, stage B 19例, stage C 50例, stage D 35例であり, 組織学的分化度は, 高分化型腺癌 26例, 中分化型腺癌 47例, 低分化型腺癌 34例であった.stage別の5年生存率はB 93.8%, C 82.1%, D 56.9%でCとDの間には有意差を認めた.病理組織別5年生存率は高分化型腺癌100%, 中分化型腺癌78.0%, 低分化型腺癌53.2%で高分化型と低分化型の間には有意差が認められた.病理組織別5年非再燃率は高分化型腺癌100%, 中分化型腺癌64.9%, 低分化型腺癌44.5%で高分化型と中分化型の間, 高分化型と低分化型の間には有意差が認められた.stage C症例における手術施行例と手術非施行例の5年生存率, 5年非再燃率に有意差を認められなかった

One hundred and seven patients with prostate cancer were treated at Mie University Hospital during the past 12 years between 1988 and 1999. They were between 53 and 83 years old, with an average age of 70.8 years old. The clinical stage was defined as A, B, C and D in 3 (2.8%), 19 (17.8%), 50 (46.7%) and 35 (32.7%) patients, respectively. At initial diagnosis, the tumor was well, moderately and poorly differentiated adenocarcinoma in 26 (24.3%), 47 (43.9%) and 34 (31.8%) patients, respectively. The median follow-up period was 52.3 months. The overall 1, 3 and 5-year survival rates were 98.0%, 86.8% and 75.2%, respectively. The 5-year survival rates for stage A, B, C and D were 100%, 93.8%, 82.1% and 56.9%, respectively. A significant difference (p = 0.017) in 5-year survival rate was noted between stage C and D. The 5-year survival rate was 100% for well differentiated, 78.0% for moderately differentiated, and 53.2% for poorly differentiated adenocarcinoma. A significant difference (p = 0.0016) in the 5-year survival rate was noted between well differentiated and poorly differentiated adenocarcinoma. According to the therapy, the 5-year survival rate in stage C was 86.2% for the radical prostatectomy group and 84.0% for the endocrine therapy group. There was no significant difference between these 2 treatment groups. Endocrine therapies, classified into maximum androgen blockade (MAB) and endocrine therapy other than MAB were performed for stage D as an initial therapy. Although the prognosis in the patients treated with MAB was better than that with other endocrine therapies, there was no significant difference between these 2 endocrine treatment groups.