再発前立腺癌の新臨床効果判定基準による化学療法の評価

Abstract

1)再燃前立腺癌82例に対する化学療法の効果をみるため新しく提唱した方法(泌尿器科紀要・投稿中)に基づき評価を行った.2)前立腺局所, 骨転移, 軟部組織転移, PAPの4項目を個別に評価し, それを合算して総合評価を行ったところ, PRとstableをそれぞれ19%および27%に認め, 両者は有意な生存期間の延長をみた.3)前立腺局所と骨転移は測定方法が鋭敏なものでないため, 総合評価との一致率が低かった.4)軟部組織とPAPは治療効果を鋭敏に反映した.特にPAPは異常値からの正常化が生存期間を延長する要因として認められた.5)化学療法により自覚症状が改善されることが多いが, 他覚的所見の総合評価とはかならずしも一致しないことが多かった.6)治療効果に影響を及ぼすものとして, 既治療の内容, performance state, 年齢, 病変数, stageがあったが, 初回治療時の組織学的分化度は関係がなかった.7)新しく提唱された評価方法の妥当性が認められた

Effect of chemotherapy for relapse of prostatic cancer was evaluated with new response criteria, in which four objective parameters including the prostate, bone metastasis, soft tissue metastasis and the serum acid phosphatase level estimated by radioimmunoassay or enzyme immunoassay were judged separately and then summarized to evaluate the response as complete response (CR), partial response (PR), stable and progressive disease (PD). Eighty-two patients were included in the study. Rate of PR and stable were 19% and 27%, respectively, and these two groups showed longer survival than those with PD. Evaluation of prostate and bone showed tendency to be discrepant with total judgement. Evaluation of soft tissues and prostatic acid phosphatase reflected the effect of chemotherapy. Chemotherapy often improved subjective symptoms but the effect did not parallel the total judgement in many cases. Factors influencing response of chemotherapy were mode of pretreatment, performance status, age, number of affected areas and clinical stage, but the grade at initial treatment was not correlated to response. The new criteria used in this study was valid for evaluation of response in prostatic cancer.