根治的前立腺全摘除術を施行した前立腺癌リンパ節転移陽性例における即時アンドロゲン除去アジュバント療法に関する検討  [in Japanese] THE EVALUATION OF IMMEDIATE ANDROGEN DEPRIVATION ADJUVANT THERAPY IN PATIENTS WITH LYMPH NODE POSITIVE PROSTATE CANCER AFTER RADICAL PROSTATECTOMY AND PELVIC LYMPHADENECTOMY  [in Japanese]

(目的)前立腺全摘除術におけるリンパ節転移陽性例に関して臨床的検討し,さらに術後即時アンドロゲン除去アジュバント療法の有無による治療効果について検討した.(対象と方法)対象は1992年1月から2008年1月までに当院で前立腺癌に対して根治的前立腺全摘除術および骨盤内リンパ節郭清を施行した874例中,術後pN1症例の62例.術前臨床病期と術後病理病期の特徴をretrospectiveに検討し,また血清PSAを6ヵ月毎に測定し0.4ng/ml以上になればbiochemical progressionと判定し全体の生化学的非再発率,疾患特異生存率および即時アンドロゲン除去アジュバント治療群と即時治療なし群の生化学的非再発率,疾患特異生存率について検討した.(結果)病理組織型はGleason 8以上が68.3%を占めリンパ節転移陽性例は悪性度が強い傾向であった.また骨盤内リンパ節転移の中で外腸骨リンパ節転移が最多であった.経過成績に関して全体では5年疾患特異生存率90.3%,5年生化学的非再発率は67.4%であった.即時アジュバントホルモン療法の有無により5年疾患特異生存率に有意差なく,5年生化学的非再発率において即時LH-RHアナログのみ群およびMAB療法群の方が即時治療なし群と比較して有意に高値であった.(考察)Retrospectiveでnonrandomizedな研究であるが前立腺全摘除術後のリンパ節転移陽性例では術後即時のアンドロゲン除去アジュバント療法が即時治療しない群と比較して再発に対して有効である可能性が示された.

(Purpose) We assessed the outcome after radical prostatectomy and pelvic lymphadenectomy for lymph node positive prostate cancer retrospectively. Furthermore, we compared the efficacy of immediate androgen deprivation adjuvant therapy in node positive patients who have undergone radical prostatectomy. (Material and methods) We investigated 62 patients who have undergone radical prostatectomy and pelvic lymphadenectomy and have been found to have lymph node positive prostate cancer at our facility between January 1992 and January 2008. We researched the clinical stages, the pathological stages and Gleason scores for pathological pN1 + prostate cancer, retrospectively. The serum PSA levels were followed up every 6 months, and we considered that biochemical progression was PSA>0.4ng/ml. We classified the groups treated with or without immediate androgen deprivation adjuvant therapy, the biochemical progression free survival and cause specific survival were analyzed by the Kaplan-Meier method, and the statistical significance was determined by the log rank test. (Results) The rate of lymph node positive patients who have undergone radical prostatectomy was 7.1%. The rate of 8 or greater in Gleason score of all the lymph node positive patients was 68.3%. The 5-year prostate cancer specific survival and 5-year biochemical progression free survival rates were 90.3 and 67.4% of all the patients. The biochemical progression free survival rate of the group of patients who have received immediate androgen deprivation therapy after radical prostatectomy was significantly higher than that of the group of patients who have not received immediately androgen deprivation therapy. (Conclusion) It may be suggested that early androgen deprivation adjuvant therapy benefits patients with nodal metastases who have undergone radical prostatectomy and lymphadenectomy, compared with those who received deferred treatment, although in a retrospective nonrandomized study.