前立腺癌における各腫瘍マーカーの臨床的意義 : 前立腺酸性フオスファターゼ(PAP),前立腺特異抗原(PA),γ-セミノプロテイン(γ-Sm)の比較検討―

Abstract

PAP, γ-Sm, PAの同時測定を行い, それぞれの有用性と相関性を検討したので報告する.臨床病期の進行や原発病巣の範囲と測定値とは相関しなかった.PA-1よりPA-2が高値を示すことが多く, 検出率はPA-2, 特異性はPAP, 診断精度はPA-1が最も良好であった.未治療前立腺癌における陽性率は三者併用の陽性率が高かった.全測定検体では各マーカー値間の相関係数は高くなく, 三者は臨床的に異なるマーカーと考えられた.組織学的分化度と各マーカー測定値との間に一定の関係は見られなかった.低分化型の症例では治療後もPAが異常値に止まる傾向があった.いずれのマーカーでも再燃例は制癌例に比べて有意に高い値であった.また再燃例ではPA-1が最も高い異常値率を示した

We measured the prostatic acid phosphatase (PAP), gamma-Seminoprotein (gamma-Sm) and prostate specific antigen (PA) in the serum of 862 patients with various urologic diseases including 89 patients with prostatic cancer. We used a PAP radioimmunoassay kit, gamma-Sm enzyme immunoassay kit, Markit-F-PA enzyme immunoassay kit and PA test Wako enzyme immunoassay kit. Serum PA level in advanced prostatic carcinoma (stage C, D) tended to be higher than that in early stage cancer (stage A, B). The Wako kit gave a higher PA than the Markit-F in each stage. The sensitivity rate of Wako PA test was the highest (81%) of all kits. The specificity rate of PAP was the highest (83%), and the accuracy rate of Markit-F PA was the highest (79%). The positive rate in the combined assay of PAP, gamma-Sm and PA in prostatic cancer was higher than that in the single assay of each tumor marker. We regarded PAP, gamma-Sm and PA as clinically different tumor markers, because their serum level did not correlate definitely. No apparent correlation was found between histopathological grade and the level of each tumor marker. The level of PAP, gamma-Sm and PA in the reactivated patients was significantly higher than that of the well-controlled patients. In the reactivated patients, the positive rate of Markit-F PA was the highest (89%) of all the kits.