前立腺癌Stage A : 本邦規約とTNMとの比較及び予後

Abstract

前立腺肥大症と診断された3294例に対しTUR-Pを実施した.stage Aは144例であり, このうちチップ数及び組織学的分化度の判明している136例について検討した.stage Aの患者数と亜分類の比は, PSA検査導入以後のT1c症例増加と関係がなかった.PSA測定開始後のA1の52例中24例, A2の32例中25%がPSA異常値, 生検陰性であり, TUR-Pによりstage Aと診断された.136例のA1及びA2症例をTNMで再分類を行い比較したところ, A1でT1aと一致したのは88例, A2でT1bと一致したのは39例で, 127例に両分類の一致をみた.不一致は9例であった.PSAの再上昇はA1T1aの7例, A2, T1aの1例, A2T1bの2例にみられた.癌死は2例であった.治療法はまちまちであるがA1T1aは良い予後であり, A2T1bはやや低い生存率を示した

Between 1980 and June, 2002, transurethral resection of prostate was performed against 3294 cases of benign prostatic hyperplasia, and 144 cases of stage A cancer were detected (4.4%). Among these cases, 136 cases which had complete records of examination were studied. Annual number of stage A and A1:A2 ratio were not influenced by introducing PSA determination from 1991, although the number of T1c has been increasing gradually. Since subclassification of stage A is different between Japanese rules (A1; 3 chips of cancer with well-differentiated adenocarcinoma, A2; others) and TNM (T1a; 5% of less number of chips with cancer, T1b; others), two criteria were compared. Coincidence was found with 93.7%, and disagreement was due to ratio of number of chips with cancer to whole number resected, or different grade. The former difference was caused by a larger or smaller prostate. Most cases of A1 and A2 were subjected to watchful waiting or subsequent therapy. PSA was elevated in 10 cases (7%), two of which died from progression of cancer. Other cases were disease-free. Individual pathological findings are important for subclassification of stage A.