前立腺がんの男性におけるがん進行の生物学的決定因子

T A Stamey¹, J E McNeal, C M Yemoto

¹Department of Urology, School of Medicine, Stanford University, Calif, USA. tstamey@leland.stanford.edu

JAMA

|April 27, 1999

まとめ

前立腺がんの進行は,高度のがんの割合 (グリーソン4/5級) と腫瘍の容量に関連しています. これらの要因の正確な測定は,患者の病気の進行を予測するために重要である.

科学分野:

腫瘍学腫瘍学
泌尿病理学泌尿病理学について
手術病理学の病理学

背景:

前立腺腺がんの診断能力の向上は,治療決定に課題をもたらす.
前立腺がんの進行を正確に予測することは,効果的な患者管理に不可欠です.

研究の目的:

前立腺がんの進行と修正されたグリーソン格付けシステムとの関連を調査する.
疾患の進行を予測する形態学的および臨床的変数を特定する.

主な方法:

ラジカル前立腺切除術で治療された前立腺がんの周辺部を有する379人の男性の遡及的分析.
8つの形態学的変数の評価,グリーソングレード4/5の%を含む,がんの容量,血管の侵入,リンパ節の関与.
血清の前立腺特異抗原 (PSA) 濃度の増加によって定義される生化学的進行.

主要な成果:

グリーソングレード4/5の割合 (% グリーソングレード4/5) と癌の容量は,進行を非常に予測していました.
陽性なリンパ節発見と前立腺内血管侵入も重要な予測要因でした.
伝統的なグリーソンスコア,カプスラー貫通,そしてポジティブな外科的限界は,失敗の独立した予測要因ではなかった.

結論:

%グリーソングレード4/5,がん容量,陽性リンパ節,および前立腺内血管侵入は,前立腺がんの進行と独立して関連しています.
改善された予測のために,がんの体積と4%のグリーソングレード4/5の正確な測定技術が必要です.
カプスラー浸透率やポジティブな手術マージンなどの既定の予測要因は,急性前立腺切除術後の独立した予測値を示さなかった.

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