臨床病期B,Cにおける前立腺全摘除術の検討 Neoadjuvant療法施行群と手術単独群の比較

Abstract

臨床病期B, Cにおける前立腺全摘除術について検討した.対象は, 前立腺癌臨床病期B, Cで前立腺全摘除術を施行し, 術後アジュバント療法を施行していない80例(平均65.9歳)で, ネオアジュバント療法施行群35例(病期B18例, C17例), 手術単独群45例(病期B40例, C5例)に分けて比較した.その結果, ネオアジュバント療法群と手術単独群のunderstagingはそれぞれ11.4%(4/35), 44.4%(20/45), overstaging(あるいはネオアジュバント療法によるdownstaging)は22.9%(8/35), 0.0%(0/45)であった.臨床病期B, Cでは両群間で前立腺特異抗原(PSA)非再発率に差は認めなかった.病理学的病期Bの5年PSA非再発率はネオアジュバント療法群63.2%, 手術単独群にPSA再発はなかった.病理学的病期Cの5年PSA非再発率はネオアジュバント療法群で低い傾向であったが, 有意差は認めなかった.以上, 術前ネオアジュバント療法の意義はほとんどないと示唆された

Between 1994 and 2001, 80 patients underwent radical prostatectomy without adjuvant therapy for clinical stage B and C prostate cancer. The patients were not treated with adjuvant therapy before biochemical prostate specific antigen (PSA) failure. Of all 80 patients, 35 patients (43.8%) received neoadjuvant hormonal therapy prior to radical prostatectomy (the neoadjuvant therapy group), 45 patients (56.2%) underwent prostatectomy alone (the surgery alone group). Retrospective analysis to evaluate the effects of neoadjuvant therapy was performed from clinicopathological findings and the biochemical PSA failure-free rate. Of all patients, 58 (72.5%) were in clinical stage B and 22 (27.5%) were in clinical stage C. Of 58 patients in clinical stage B, 19 (32.8%) underwent prostatectomy combined with neoadjuvant therapy. Of the 22 patients in clinical stage C, 17 (77.3%) underwent prostatectomy combined with neoadjuvant therapy. Pathologically, 37 (46.3%) were in stage B, 38 (47.5%) in stage C and 2 (2.5%) in stage D1. Three patients in the neoadjuvant therapy group had no malignant findings in specimens of prostatectomy. In comparison with the clinical stage, pathologically 8 (22.9%) showed overstaging, 4 (5.0%) understaging and 23 (28.8%) accurate staging in the neoadjuvant therapy group, respectively, 0 (0.0%), 20 (44.4%), and 25 (55.6%) in the surgery alone group. In clinical stage B and C, there was no significant difference in the biochemical PSA failure-free rate between the neoadjuvant therapy group and the surgery alone group. On the other hand, in pathological stages B, the 5-year PSA failure-free rate was 63.2% in the neoadjuvant therapy group, but 100% in the surgery alone group. Although neoadjuvant therapy may have some effect on downstaging, our retrospective analysis suggests that it has no significant effect on PSA failure-free rate.