StageD1前立腺癌の検討 - リンパ節の転移様式およびstageD1前立腺癌の予後 -

Abstract

限局性前立腺癌70例にstaging pelvic lymphadenectomy(うち前立腺全摘術37例)を行い, リンパ節の転移様式およびstage D1前立腺癌の予後について検討を加えた.1) 70例中21例にリンパ節転移を認めた.2) stage別のリンパ節転移頻度は, stage A2で4/11, stage B1で1/19, stage B2で4/20, stage Cで12/20であった.3) grade別のリンパ節転移頻度は, 高分化腺癌で1/21, 中分化腺癌で11/36, 低分化腺癌で9/13であった.低分化になるほど転移リンパ節のnodal volumeは増加していた.4) stage D1症例のdiscase free survivalは, リンパ節転移陰性例に比較して有意(p<0.001)に不良であった.5)転移リンパ節のnodal volumeによる予後の差は認められなかった.6) stage D1前立腺癌はホルモン療法の有無にかかわらず不良であり, 早期に補助療法を検討すべきと考えられた

Between 1982 and 1988, 70 patients with proved prostatic adenocarcinoma in stages A2 to C underwent pelvic lymphadenectomy. Median followup has been 30 months. Radial prostatectomy was done in 37 patients, 3 of whom were followed by immediate hormone therapy. Twenty eight patients received radiotherapy alone except one combined with hormone therapy. The remaining 5 patients were treated hormonaly alone. Pelvic lymph node metastases were noted in 21 of the 70 patients (30%). High stage and poor histological differentiation were associated with a significantly higher probability of pelvic lymph node metastases. Poor histological differentiation was more likely to be found in patients with multiple or gross node involvement. Progression of the disease, almost exclusively bony metastases, occurred in 10 of the 21 patients who had positive pelvic nodes and in 7 of the 49 patients with negative nodes (p less than 0.01). According to Kaplan-Meier projections, 1, 3 and 5 year percent disease free survival were, respectively; 73%, 32% and 32% for patients with positive node, and 93%, 82% and 75% for patients with negative nodes. Disease-free survival of stage D1 patients was significantly worse than that of patients with negative nodes (p less than 0.001, Generalized-Wilcoxon test). We divided 21 patients with pelvic nodal metastases into subgroups based upon the volume and extent of nodal disease; 7 patients with a single microscopic nodal involvement and 14 patients with multiple or gross nodal involvement. There was no significant difference in disease free survival between the two groups. 9 of the 21 patients were given hormonal treatment immediately and on the contrary, 12 were followed without hormonal treatment. However, projected disease free survival differed little between the groups. These data suggest that patients with positive nodes appear to have equivalent adverse biologic potential and should be considered candidates for early systemic treatment.