前立腺癌に対する根治的前立腺摘除術後の病理学的病期診断を予測する因子に関する検討  [in Japanese] PREOPERATIVE PARAMETERS, INCLUDING PERCENT OF POSITIVE BIOPSY CORES, IN PREDICTING PATHOLOGICAL FINDINGS AFTER RADICAL PROSTATECTOMY  [in Japanese]

(目的)和歌山県立医科大学泌尿器科において施行した根治的前立腺摘除術症例における病理学的病期診断を予測する術前因子に関して検討した.(対象と方法)1999年5月より2004年12月までの間に臨床病期T2以下の局所前立腺癌と診断され,根治的前立腺摘除術を施行した160症例を対象とした.今回の検討には,臨床病期T3の患者は含まれていない.術前の予測因子として年齢,Body Mass Index,術前PSA値,生検組織におけるGleason score,針生検陽性率(%PosBX),優位側における針生検陽性率(%DomPosBX)を採用し,これらの因子が摘出標本における病理学的病期診断の予測因子となりうるか否かについて単変量解析および多変量解析によって検討した.(結果)単変量解析では,術前PSA値(p<0.001), Gleason score (p=0.007),臨床病期(p=0.026),%PosBX(p=0.002)および%DomPosBX(p<0.001)が病理学的病期診断と有意に相関していた.多変量解析では術前PSA値とGleason scoreおよび5%DomPosBXが独立した予測因子であった.これらの因子を用いて病理学的限局性前立腺癌(pathological organ confined disease : pOCD)の予測表を作成した.(結論)術前PSA値とGleason score あるいは術前PSA値と%DomPosBXを組み合わせることによって病理学的限局性前立腺癌の予測表を作成した.根治的前立腺摘除術の適応および術後の補助療法などを考慮するうえで一助となる可能性があるものと考えられた.

(Objectives) We investigated whether preoperative parameters predict pathological stage at radical prostatectomy for patients with clinically localized prostatic cancer. (Materials and methods) We studied a total of 160 men with clinically localized prostatic cancer (less than or equal to clinical T2) who underwent radical rertropubic prostatectomy at Wakayama Medical University. Clinical Ts patients are not included in this study. Preoperative parameters include patient age, Body Mass Index, preoperative serum PSA value, biopsy Gleason score, clinical stage, the percent of positive biopsy cores (%PosBx) and the percent of positive biopsy cores on the dominant side (%DomPosBx). Univariate and multivariate analysis were performed to examine the prognostic significance of these preoperative parameters. Significant independent factors were combined to create a table to predict pathologically organ confined disease. (Results) Univariate analysis showed preoperative serum PSA value (p<0.001), biopsy Gleason score (p=0.001), clinical stage (p=0.026), %PosBx (p=0.002) and %DomPosBx (p=0.003) were significantly related to the pathological stage. On multivariate analysis, serum PSA value (p<0.01), biopsy Gleason score (p<0.05) and %DomPosBx (p<0.05) were significant independent predictors of pathological stage. (Conclusion) We provide two model combinations using preoperative clinical factors, one is a combination of serum PSA and biopsy Gleason score and the other is a combination of serum PSA and %DomPosBx, which define a new preoperative model for predicting pathological organ confined prostatic cancer. These combinations are useful and provide important information for urologists to determine the appropriate treatment strategy for clinically localized prostatic cancer.