前立腺全摘症例の臨床的検討

Abstract

術後3ヵ月以上経過した31例を検討対象とした。生存期間中央値は32ヵ月(3-95ヵ月)で, 5例が死亡した。その死因は2例が前立腺癌, 1例が心筋梗塞, 1例が肺炎, 1例が術後死であった。再発は4例に認められた。stage Bの1例は術後22ヵ月目に骨転移が生じたが, 去勢術と前術したmethotrexate投与にてPR状態で32ヵ月, pN1の1例は術後53ヵ月目に尿道膀胱吻合部に再発し, Honvanの経口投与と局所放射線療法によりCR状態で95ヵ月いずれも生存中である。残りの2例はpN2症例で, 1例は術後34ヵ月目に尿道膀胱吻合部と骨に, 1例は4ヵ月目に頸部リンパ節に再発し, 前者は65ヵ月, 後者は23ヵ月後に癌死した

Total retropubic prostatectomy was performed on 31 patients with prostatic cancer (median age; 70 years). The accuracy of staging was 55% (17 patients). In 11 patients (35%) the staging had been underestimated, and in 3 patients (10%) overestimated. The pathological stage and grade were stage B in 14 patients, stage C in 4 patients, stage D1 in 13 patients (pN1; 8 patients, pN2; 5 patients), well differentiated adenocarcinoma (WDA) in 8 patients moderately differentiated adenocarcinoma (MDA) in 7 patients, and poorly differentiated adenocarcinoma (PDA) in 16 patients. The WDA were all stage B, and 85% of the PDA were stage D1. The positive surgical margin rate was 21% in stage B, 50% in stage C, 85% in stage D1, 13% in WDA, 43% in MDA, and 75% in PDA. Five of the patients died, and the causes of death were prostatic cancer in 2 patients (pN2/PDA), and others in 3 patients (1 patient; stage B/PDA, 2 patients; pN2/PDA). The 5-year survival rate (Kaplan-Meier) was 84% on the whole, 83% for stage B, 100% for stage C, 83% for stage D1, 100% for WDA, 100% for MDA, 71% for PDA, 86% for pN0, 100% for pN1, and 38% for pN2.