前立腺癌に対する根治的前立腺全摘除術及び骨盤内リンパ節郭清術の検討 リンパ節郭清術の意義について

Abstract

前立腺癌臨床病期stage A2, B, Cの症例44例について検討した. 1)術後の5年生存率は, リンパ節転移陽性例で77%, 陰性例で90%であり, 5年の術後無病率は, リンパ節転移陽性例で54%, 陰性例88%であった.根治的前立腺全摘除術及び骨盤内リンパ節郭清術は, 臨床病期stage C以下の前立腺癌症例に対して有用な方法と考えた. 2)臨床病期stage D1症例に対する根治的前立腺全摘除術の是非については, QOL等を含めたrandomized studyによる確認が必要と考えた. 3)リンパ節転移陽性の14例32%の転移部位は, 閉鎖節8例57%, 内腸骨節6例43%, 外腸骨節6例43%, 総腸骨節4例29%, 正中仙骨節2例4%であった

Between September, 1987 and September, 1993, a total of 44 consecutive patients had undergone radical retropubic prostatectomy and pelvic lymphadenectomy for the treatment of prostate cancer. The patients were between 56 and 77 years (mean, 68 years). Eleven patients had clinical state A2 disease, 21 had stage B disease, and 12 had stage C disease. Fourteen of the 44 patients (32%) had positive lymph node metastases. The 5-year survival rate for patients with pT1, pT2 and pT3 was 100%, 71% and 87%, respectively. It was 77% in patients with positive node disease and 90% in patients with negative node disease. The 5-year disease-free survival rate for patients with pT1, pT2 and pT3 was 82%, and 78%, respectively. It was 54% in patients with positive node disease and 88% in patients with negative node disease. In 14 positive node patients, metastases were located in obturater nodes in 8 patients (57%), hypogastric nodes, in 6 patients (43%), external iliac nodes in 6 patients (43%), common iliac nodes in 4 patients (29%) and presacral nodes in 2 patients (14%). We confirmed that radical retropubic prostatectomy is effective treatment for locally confined prostate cancer and removal of obturater, hypogastric lymph nodes and the internal chain of external iliac lymph nodes is important in detecting metastases.