難治性前立腺癌に対する治療の現状と問題点 : 前立腺全割標本を用いたネオアジュバント療法の臨床病理組織学的検討

Abstract

ネオアジュバント内分泌療法を施行した前立腺癌62例(A群)と非施行の76例(B群)を比較した.術前PSA値はA群で有意に高く, 臨床病期もhigh stageが多かった.被膜外浸潤, 断端陽性率, リンパ管侵襲の頻度はA群が低かったが, 精嚢浸潤, リンパ節転移は差がなかった.A群の組織学的効果はpoorが18例, goodが26例, excellentが17例であった.excellentへの影響因子を検討したところ, 治療期間のみが有意で, 年齢, 治療前PSA値, 臨床病期, 生検分化度, 生検陽性コア数は有意な関連がなかった.病理組織学的に限局癌である症例はA群34例, B群25例で, A群で臨床診断T2b以下は20例であった.これらのPSA failureは, A群がB群に比較して僅かに頻度が高く, A群のexcellent例はPSA failureの頻度が低い傾向にあった

We investigated whether the histopathological effect (cell viability) of neoadjuvant hormonal treatment before radical prostatectomy for clinically localized prostate cancer is involved in the biochemical outcome, i.e., androgen independency. Non-randomized prospective trial was carried out between September 1996 and April 2001 involving the patients with clinical stage T1-3 prostate cancer, including 62 who underwent radical prostatectomy after receiving neoadjuvant hormonal treatment for an average of 6.3 months and 76 who underwent radical prostectomy only. All resected specimens were histopathologically diagnosed by whole section analysis. The patients receiving neoadjuvant hormonal treatment were categorized into 4 groups according to the histological change in the resected prostate. There were 8 patients in G0 (all viable cells), 11 patients in G1 (more than 50% viable cells), 26 patients G2 (more than 50% non-viable cells) and 17 patients in G3 (no cancer cells). No difference in the patient background (prostate specific antigen, stage, Gleason score, positive core Nr, duration of neoadjuvant therapy) was observed in any group, except for the duration of (p < 0.05). Multivariate hazards analyses revealed that only the duration of neoadjuvant hormonal treatment was independently associated with excellent responders with grade 3 histological effect. Neoadjuvant hormonal therapy prior to radical operation resulted in various histopathological changes in the prostate, but it is not clear whether the histological effects of hormonal treatment might be involved in the outcome. A longer follow-up randomized prospective trial is necessary.