精巣腫瘍における血清フェリチン値の検討

Abstract

1983年1月より1989年6月までに17例の精巣腫瘍を経験した.初診時年齢は18歳～46歳(平均31.8±7.6歳)で患側は左側5例, 右側11例であった.病理組織所見はseminoma 7例, non-seminoma 9例であった.seminomaの2例ではsyncytiotrophoblastic giant cells (STGC)を確認した.病期はseminomaでは1が2例, 2が3例, 3が2例であり, non-seminomaでは1が4例, 2が2例, 3が3例であった.全例に除睾術を行っている.化学療法はPVB療法を主体とし, 症例によってはPV療法またはCDDP単独療法, CDDP+VP-16併用療法を施行した.seminomaの7例中6例に放射線治療を施行した.non-seminomaの1例も左鎖骨上窩腫瘤に対し放射線治療を行った.14例が癌なし生存であり, 期間は1年2ヵ月から7年6ヵ月(平均35.4±24.6ヵ月)であった.死亡はnon-seminomaの2例で, 1例は1年10ヵ月で癌死, 1例は4ヵ月で化学療法による骨髄不全にて死亡した

The clinical value of serum ferritin level in patients with testicular cancer was studied. Seven cases of seminoma and nine cases of non-seminoma from 1983 to 1989 were evaluated. The serum levels of ferritin, human chorionic gonadotropin (beta-HCG), alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA) and lactate dehydrogenase (LDH) were estimated before and after treatment. Abnormally high values of serum ferritin before treatment were noted in 4/7 (57%) in seminoma, 3/9 (33%) in non-seminoma and 7/16 (44%) in total. The total rate showing abnormally high values of serum ferritin was lower than that of beta-HCG and LDH. Meanwhile it was the same as that of AFP and higher than that of CEA. Changes in the serum ferritin level did not always correspond with the clinical course. In 3 out of 6 tumor free patients, higher levels of serum ferritin before treatment became normal after treatment. In one patient with a high level of serum ferritin before treatment, the level of serum ferritin remained higher and retroperitoneal lymph node metastasis developed after treatment. In 9 cases with normal serum ferritin level, 7 showed the normal range of ferritin level throughout the treatment course. These findings suggests that in some patients with testicular cancer, the serum ferritin level might serve as a tumor marker indicating the efficacy of the treatment and the tumor recurrence.