再燃前立腺癌の臨床的観察

Abstract

初診時の病期と再燃までの期間については, 28例中14例をしめる病期D2では, 病期Cに比べ有意に再燃までの期間が短く, 15.6±3.2ヵ月であった.再燃時の組織学的検索は5例になされ, うち3例はより低分化に変化していた.治療効果はPR 3例, NC 4例, PD 21例であり, PR 3例のうち2例はエトポシドを基本とした化学療法を施行した.28例中20例が前立腺癌死し, 8例は生存中であり, 再燃後の実測生存率は1年が49.3%, 3年が12.5%ときわめて不良であった

Between 1977 and 1989, we treated 114 new patients with prostatic cancer, and 99 of them responded to initial hormone-based treatment. Recurrence was seen in 28 of the 99 responders. The age at first admission ranged from 56 to 84 years, with a mean of 72.4 years. The mean interval between the start of follow-up and recurrence was 21.0 +/- 15.4 months (M +/- SE). The interval was 33.3 months for patients in stages B2 and C at initial treatment, 34.3 months for those in stage D1, and 15.6 months for those in stage D2. Stage D2 patients showed significantly earlier recurrence than the other patients (p less than 0.05). Patients with well, moderately, or poorly-differentiated adenocarcinoma at initial treatment developed recurrence after 62.5, 14.8, and 23.0 months, respectively, and there was no significant difference due to histological grade. As the mode of recurrence, the appearance of new lesions and the elevation of tumor marker levels were more frequently seen than local progression in patients with progressive disease at initial treatment. Pathological examination showed the tendency of recurrence for higher grade tumors. In comparison with those without recurrence, patients with recurrence had more advanced disease (p. 0.05). Only 11% of the patients showed partial response (PR) and 14.3% showed no change (NC) with multimodal therapy. The actual survival rates following initial treatment were 51.5% and 31.2% at 3 and 5 years, respectively, while those after recurrence were 49.3% and 12.5% at 1 and 3 years.