前立腺癌 : 内分泌療法の成績と問題点

Abstract

1975年～1988年の14年間に治療した184例(平均年齢73.4±8.3歳)の治療成績を基に内分泌療法の問題点を検討した.1)症例の臨床病期はA 18例, B 22例, C 49例, D 95例で, 5年, 10年生存はA:16例と12例, B:11例と6例, C:29例と11例, D:32例と21例であった.2)経口投与薬剤はHonvan, Estracyt, CMAであり, 薬剤に加え除睾した57症例の5年生存, 10年生存は30例と14例で, 非除睾104例の40例と15例よりよい.また治療開始時のHonvan静注63例の5年生存は34例, 7年生存は21例で, 静注なし40例の18例, 12例よりよい.3)この成績は内服薬剤による内分泌療法では, その服用と持続が確実でない結果を示すものと思われる.4)内分泌療法に伴う心, 脳血管障害は多くはなく, 従来から本邦で行われて来た, Honvan静注後に除睾し, estrogen剤を投与するregimenは, 全体的に心血管系障害が増加しているとはいえ, 現在でも前立腺癌の治療にあたって臨床上の有用性を保っているといえよう

Efficacy of orchiectomy and intravenous administration of diethylstilbestrol diphosphate (DESP) for the treatment of prostatic carcinoma was evaluated on 184 patients treated between 1975 to 1989. The patients were between 49 to 88 years old with a mean age of 73.4 +/- 8.3 years. Clinical stage was A in 9.8%, B in 12%, C in 26.6% and D in 51.6%. The histologically well, moderately and poorly differentiated adenocarcinoma were observed in 20.9, 29.4 and 49.7%, respectively. The 5-year survival rate of stage A, B, C and D calculated with the Kaplan-Meier method were 90, 49, 60 and 34%, respectively. The 5- and 10-year survival rate of the patients who had received orchiectomy was 53 and 24%, respectively, while that of the patients without orchiectomy was 38 and 14%, respectively. The 5 and 7-year survival rate of the patients treated with intravenous administration of DESP was 54 and 34%, respectively while that of the patients without DESP was 46 and 31%, respectively. These findings suggest that orchiectomy and intravenous administration of DESP in any form prolonged patient survival compared with only oral administration of estrogens or antiandrogens. Reactivation was seen in 24 (40%) of the 60 patients under sufficient observation. Clinical relapse occurred within an average of 32.3 +/- 26.4 months after primary hormonal manipulation. The average time to relapse in stage D was shorter than that in stage B and C. Reactivation was observed in the patients on interrupted treatment earlier than in the patients on continuous administration of drugs. Cardiovascular death followed by endocrine therapy was 7.4% in this study.