前立腺癌に対する女性ホルモン療法の副作用 京大泌尿器科症例109例の臨床統計的観察

Abstract

1)1980～1990年に京大病院に入院した前立腺癌症例の223例中, 109症例に合成エストロゲンが投与され, そのうち53例になんらかの副作用を認めた。2)合成エストロゲンの副作用は心臓疾患:20.2%, 体液貯留(体重増加および浮腫):14.7%, 高血圧:13.8%などで, 5症例は致死的であった。3)合成エストロゲンの副作用が認められた53症例のうち, 46例の症例においては投与を中止し, 他の治療法に変更した。4)心・血管疾患の既往歴, 心電図異常は副作用発現の危険因子である

Since the introduction of hormonal treatment for prostatic cancer by Huggins and Hodges in 1941, severe side effects of synthetic estrogen, which have overcome its benefit, have been reported in the U.S.A. and in European countries. However, in Japan the adverse effects of estrogen have been reported to be milder than in western countries, and estrogen still has an important role in the treatment of prostatic cancer in Japan. In this communication, the side-effects of synthetic estrogen administered to 109 prostatic cancer patients, who were admitted to Kyoto University Hospital between 1980-1990 are reported. Fifty-three (48.6%) of the 109 patients suffered adverse side effects of the estrogen, specifically cardiac disease (20.2%), fluid retention (14.7%) and hypertension (13.8%). Five of these patients died. Among the risk factors analyzed, daily dose, past history of cardio-vascular disease and ECG abnormalities were significantly correlated with the appearance of adverse effects. The reasons why the frequency of lethal side-effects is lower in our cases compared to findings reported by the Veterans Administration group may be the lower daily dose and cessation of estrogen administration when mild adverse effects appear and some other unknown factors, although the background of the patients and method of analysis are not comparable among them. The overall frequency of side-effects in prostatic cancer patients administered estrogen in our cases is not necessarily lower than in western countries, but the severity of the side effects was milder in our cases. We must be a ware of the potential adverse effects of estrogen.