尿路悪性腫瘍患者における血清Ferritin,CEA,β2-MG,PAPに関する検討

Abstract

尿路悪性腫瘍患者における血清ferritin, carcinoembryonic antigen (CEA), β2-microglobulin (β2-MG), prostatic acid phosphatase (PAP)のパラメーターとしての有用性を, 腎癌6例, 腎盂尿管癌9例, 膀胱癌29例, 前立腺癌33例の計77例について検討した.腫瘍の悪性度と進展度は便宜的にwell群とpoor群, early群とadvanced群に大別したが, 前立腺癌の進展度についてはstage A, B群をearly群, C, Dをadvanced群とした.腎, 腎盂尿管, 膀胱癌ではferritin, CEA, β2-MGともpoor群, advanced群に上昇傾向を認めたが, 大部分が正常範囲内にあった.β2-MGは腎機能障害に強く影響されることも判明した.前立腺癌ではPAPおよびferritinが, poor群およびadvanced群で有意の上昇を認めた.また未治療例ではPAPの陽性率55.6%, ferritin 38.9%で, 再燃例ではPAP 57.1%, ferritin 85.7%, CEAとβ2-MGは大部分陰性であった.Performance statusとの関係では, とくにferritinとの間に関連性を認めた.以上より前立腺癌のモニターにはPAP, ferritinが有用であることが示唆された

Ferritin, carcinoembryonic antigen (CEA), beta 2-microglobulin (beta 2-MG) and prostatic acid phosphatase (PAP) levels in serum from 77 patients with cancer (6 with renal adenocarcinoma, 9 with renal pelvic and ureteral cancer, 29 with bladder cancer and 33 with prostatic cancer) at various stages were clinically evaluated for their significance as a parameter of urinary tract malignancies. Although, ferritin, CEA and beta 2-MG levels in the poorly-differentiated and advanced stage groups of renal adenocarcinoma, renal pelvic and ureteral cancer, and bladder cancer were higher than those in the well-differentiated and early stage groups, those in most cases were within normal ranges. These proteins were not considered suitable for the screening test. Ferritin and beta 2-MG levels increased with advancement of the performance status (P.S.) proposed by Koyama and Saito; however, the latter was affected greatly by renal impairment. In prostatic cancer, PAP and ferritin levels were remarkably high in the poorly-differentiated group (PAP mean +/- S.E.: 57.6 +/- 22.5 ng/ml, ferritin 883 +/- 319 ng/ml) and the advanced stage group (27.2 +/- 10.5 ng/ml, 398 +/- 152 ng/ml) compared to the well-differentiated group (7.87 +/- 3.61 ng/ml, 88.5 +/- 25.8 ng/ml) and the early stage group (2.24 +/- 0.54 ng/ml, 186 +/- 91.7 ng/ml). PAP and ferritin levels of the untreated cases were positive in 10 out of 18 cases (55.6%) and 7 out of 18 cases (38.9%), respectively, and those of the relapsing cases were positive in 4 out of 7 cases (57.1%) and 6 out of 7 cases (85.7%), respectively. However, CEA and beta 2-MG levels were negative in most cases. Furthermore, increments of PAP and ferritin levels, especially that of the ferritin level, were significantly related to advancement of P.S., and high ferritin levels were obtained in all cases of P.S. 3 and 4. Therefore, determination of PAP and ferritin seems to be useful in monitoring prostatic cancer, and the latter to be useful in early detection of relapsing cases.