骨転移を合併する前立腺癌にかんする臨床的研究 第2編: 血清ならびに骨髄液の酵素学的診断の価値

Abstract

Total acid phosphatase (TAP), prostatic acid phosphatase (PAP), alkaline phosphatase (AlkP) were determined on the serum of the prostatic cancer patients. TAP, PAP and LDH were examined also on the bone marrow fluid. 1. The serum TAP was high in 91.3% of the patients with bone metastasis and in 43.2 % of those without the metastasis. 56.8% of those showing high TAP had bone metastasis. 2. Elevation of the serum PAP was seen in 86.9% of the metastasis group and in 37.8 % of the non-metastasis group. 58.5% of those with high serum PAP had bone metastasis. From this, PAP was not more specific or sensitive than TAP. 3. The serum AlkP was high in 52.2% of the patients with bone metastasis and 5.9% of those without bone metastasis. High percentage (85.7%) of those with high AlkP had bone metastasis. 4. The serum LDH was high in 55 % of the metastasis group and in 21.4 % of the group without metastasis, being totally in 30%. Although no tumor specificity was recognized, the fact that 64.7 % of the patient with the elevated LDH showed bone metastasis suggests its significance as one of the indices of extention of cancer. 5. TAP of the bone marrow fluid was higher than that of the serum in 8 of 9 patients examined. Bone marrow/serum ratio of TAP was 122.8% in the non-metastasis group and 130.5% in the metastasis group, one of the cases reaching as high as 472.5%. 6. PAP of the bone marrow fluid was lower than that of the serum in 3 of 4 patients without metastasis. The average ratio was 83.7%. On the other hand, 4 of 5 patients with metastasis demonstrated PAP higher in the bone marrow fluid than in the serum. The highest ratio recorded was 1161.3%, and the average was 127.0%. 7. The bone marrow LDH was higher than the serum LDH in all 8 cases examined. The marrow/serum ratio was 205.8% in the patients without metastasis and 252.2% in those with metastasis. 8. The changes of the bone marrow enzymes seemed to precede those of the serum enzymes. The bone marrow study might be clinically significant as one of the biochemical biopsies. 9. Elevation of all of three enzymes, the serum TAP, PAP, and AlkP, was seen only in 2.7 % of the patients without bone metastasis and in 52.2 % in those with bone metastasis. Whenever three enzymes are high, the presence of matastatic bone lesion can be highly suggested. 10. Five years survival rate of the patients with normal enzyme level was estimated. Those having normal TAP showed 54.2 % being almost same as those without bone metastasis. The patient with normal AlkP showed 39.5 % and those with normal LDH 40.5 %. 11. Five years survival rate of the patients with high enzyme level was as follows. The high TAP group showed 15.3 %, the high AlkP group 0 % and the high LDH group also 0 %. These rates were worse than the rate of the metastasis group (17.3 %).