前立腺癌血清マーカー,γ-Sm, PAPの意義

Abstract

1)未治療前立腺癌群, 既治療前立腺進行群でγ-Sm, PAPの血清値は有意に高かった.2)未治療前立腺癌でγ-Sm, PAPの単独での陽性率はともに69%であった.3)γ-Sm, PAPの両者を測定することで, 陽性率は83%と上昇した.4)未治療前立腺癌群および前立腺肥大症群でγ-Sm, PAPの特異性はおのおの87%, 94.4%, 診断効率はおのおの60%, 65.1%であった.5)未治療前立腺癌群では, 臨床病期が進むほどγ-Sm, PAPは高値となり, γ-Smで病期B-C間, B-D間に, PAPで病期B-D間, C-D間に有意差をみた.6)未治療前立腺癌群では病理組織学的に低分化になるほどγ-Sm, PAPは高値, 高陽性率となる傾向をみたが, 統計学上差はなかった.7)未治療前立腺群では治療前後での正常化率は全期間(4週以上経過)ではγ-Smで66.7%, PAPで68.4%であったが, 治療開始後4週, 8週でみるとγ-Smの方が高い正常化率をしめした.8) γ-Sm, PAPそれ自体には良い相関はなかった

Between June, 1986 and December, 1987, the serum gamma-Sm and PAP was measured in 29 men with untreated prostatic cancer, 45 with treated prostatic cancer (32 were well-controlled and 13 poorly controlled), 82 with benign prostatic hypertrophy and 10 with other urological diseases. All of the patients with prostatic cancer had histologically proven disease. Enzyme immunoassay for gamma-Sm and radioimmunoassay for PAP were used. The cut-off value for gamma-Sm was 4 ng/ml and that for PAP was 3 ng/ml. The mean values of gamma-Sm and PAP were statistically high in the untreated group and also in poorly-controlled group. In the untreated group, the rate of positivity for gamma-Sm and for PAP were 69% respectively and 83% of the patients had elevated values for either or both of these markers. In clinical stage A and B, gamma-Sm and PAP values were within the normal limit, however the concentrations of mean gamma-Sm and PAP correlated well with the stage of disease. In the poorly-controlled group, positive gamma-Sm values were detected in 75% and PAP in 67%, whereas almost all of the patients had normal values for these markers in the well-controlled group. In prostatic hypertrophy, elevated gamma-Sm values were detected in 15% and elevated PAP values in 6%. After the onset of treatment, elevated values were normalized in 66.7% of the patients for gamma-Sm and in 68.4% for PAP. In the untreated group, gamma-Sm tended to show a more prompt response. In the ill-controlled group, gamma-Sm and PAP returned to normal in 50% of the patients. gamma-Sm and PAP values were well correlated with the course of the prostatic cancer and the clinical usefulness became more obvious with a combination of these markers.