前立腺癌の臨床的検討 : 予後因子について

Abstract

141例の前立腺癌を対象とした. 1)初診患者数及びstageの低い症例の割合が近年増加していた. 2)5年実測生存率は, 全体で49.9%, 臨床病期A67%, B70%, C62%, D30%, 疾患特定5年生存率は, それぞれ65.6%, 100%, 89%, 72%, 43%. 3)Gleason scoreが高いほど有意に予後が悪かった. 4)60歳未満の群でそれ以上の群に比較し, 有意に予後不良であった. 5)変数選択法を用いたCox回帰分析による検討では, 臨床病期とGleason scoreとが, PSA, 年齢, comorbidity, 初期治療に比較し, 疾患特定生存の予測因子としてより重要な変数として選択された.Gleason score 2から8では, 臨床病期が予後を規定していると考えられるが, Gleason score 9, 10では, 臨床病期に関わらず予後不良であった

To evaluate the prognostic factors and the outcome of treatment, a retrospective study was done on 141 patients with prostate cancer who were newly diagnosed at Kitano Hospital between January 1985 and November 1996. In recent years, the number of patients and the ratio of low stage cancer have increased. The overall 5-year crude survival rate was 49.9%. The 5-year crude survival rate for clinical stage A, B, C and D was 67%, 70%, 62% and 30% respectively. The overall 5-year disease-specific survival rate was 65.6%. The 5-year disease-specific survival rate for clinical stage A, B, C and D was 100%, 89%, 72% and 42%, respectively. By univariate analysis, clinical stage, Gleason score, prostate specific antigen (PSA) level, and patient age were prognostic factors for disease-specific survival of prostate cancer. According to Cox's regression analysis by the stepwise forward regression method, clinical stage and Gleason score were selected as more valuable prognostic factors than PSA level, patient age, comorbidity, and initial treatment. In Gleason score 2 to 8, the prognosis became significantly worse as clinical stage advanced, but in Gleason score 9 and 10 the prognosis was poor regardless of clinical stage.