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

Abstract

尿路悪性腫瘍における尿中ferritin, carcinoembryonic antigen (CEA), β2-microglobulin (β2-MG)のパラメーターとしての有用性を, 腎癌4例, 腎盂尿管癌7例, 膀胱癌34例の計45例につき尿中fibrin/fibrinogen degradation products (FDP), 尿細胞診とともに比較検討を行ない, 以下の成績を得た.なおhistological gradeはBrodersの分類, clinical stageはJewettらの分類を参考にして便宜上well群, poor群, early (stage)群, advanced (stage)群に大別した.尿中ferritinはwell群, early群に比しpoor群, advanced群に有意の上昇を認め, とくに腎盂尿管癌の71.4%, 上部尿路に浸潤のある膀胱癌の100%に著明高値であった.尿中CEAはpoor群, advanced群に陽性例が多かったが, 陽性率は23.1%と低かった.尿中β2-MGはpoor群, advanced群に上昇を認めたが, 大部分で腎盂腎炎などを合併しており, 腫瘍自体からの分泌は少ないと思われた.尿中ferritin, CEA, FDP, 細胞診の個々の正診率はそれほど高くないが, 四者で併用すると84.8%でスクリーニングに有用である

Ferritin, carcinoembryonic antigen (CEA) and beta 2-microglobulin (beta 2-MG) levels in urine from 45 patients with cancer (4 with renal adenocarcinoma, 7 with renal pelvic and ureteral cancer and 34 with bladder cancer) at various stages were clinically evaluated for their significance as parameter of urinary tract malignancies as compared to urinary fibrin/fibrinogen degradation products (FDP) and urine cytology. Ferritin levels for the poorly-differentiated and advanced stage groups were higher than those for the well-differentiated and early stage groups, and were especially high in 5 of the 7 patients with renal pelvic and ureteral cancer and all of the 7 patients with bladder cancer involving the upper urinary tract. These data suggest that determination of urinary ferritin is useful in the detection of urinary tract cancer involving the upper urinary tract. The upper limits of CEA levels were determined respectively according to white blood cell counts in urine. Although, CEA levels were elevated in the poorly-differentiated group and the advanced stage group compared to the well-differentiated and early stage groups, the values were positive in only 12 out of 52 cases (23.1%). These values seemed to be low compared to other reports. beta 2-MG levels increased significantly in the poorly-differentiated and advanced stage groups. However, most cases in the above groups were complicated with pyelonephritis or renal impairment. It is suggested that the urinary beta 2-MG secretion from cancer itself is not so significant.(ABSTRACT TRUNCATED AT 250 WORDS)