Search

対象はSeminoma (S) 7例, non-S 9例について検討した.Sの2例では, STGCを確認した.non-Sでは, embryonal carcinoma (E)+teratocarcinoma (T)+choriocarcinoma (C)+Sが1例, E+T+Sが2例, E+C+Tが1例, E+Cが1例, E+Sが1例, E単独が1例, immature teratomaが1例であった.フェリチンの組織陽性率94%に比較すると血清陽性率が44%と低値であった理由としては, フェリチンは本来細胞内に存在するものであるが, 血清フェリチンの上昇が認められるには, 癌組織が血管やリンパ管などを侵襲し, 組織フェリチンが細胞から解離されることが必要のためとも思われる.また今回同時に検討したβ-HCG, AFP, CEAについては, これらの腫瘍マーカーの組織局在性と組織型の関係は, 文献的にはほぼ確定していると思われる.本検討では, β-HCG, AFP CEAの組織局在性については文献と類似の結果が得られた, Localization of ferritin in testicular tumors was studied by the immunohistochemical method and the usefulness of ferritin was evaluated compared with the clinical course. Seven cases of seminoma and 9 cases of non-seminoma were used for the study. Formalin-fixed, paraffin-embedded tissue sections were stained by the avidin-biotin complex method. Commercial rabbit anti-human ferritin polyclonal antibody in 1/100 dilution was allowed to react at room temperature for one hour. In normal testicular tissues, the epithelium in germinal cells was not stained for ferritin. In seminomas, some tumor nests were stained for ferritin. Interstitial cells, especially histiocytes, were also stained for ferritin. In stained tumor cells, cytoplasm was stained uniformly. Necrotic cells were not stained. The same findings were obtained in non-seminomas. In metastatic lesions and tumor thrombi in the vessels, some tumor cells were stained as intensely as in the origin. A case was calculated positive if more than 5% of the tumor cells in the specimen were stained. The positive rate in ferritin immunostaining was significantly higher than that of human chorionic gonadotropin (beta-HCG), alpha-fetoprotein (AFP) and carcinoembryonic antigen (CEA) immunostaining with the same materials. The specimens from cases with abnormally high serum ferritin level, were stained more intensely than those from cases with normal serum ferritin level. The result suggests that ferritin might be a useful tumor marker in some of testicular tumors.

1983年1月より1989年6月までに17例の精巣腫瘍を経験した.初診時年齢は18歳～46歳(平均31.8±7.6歳)で患側は左側5例, 右側11例であった.病理組織所見はseminoma 7例, non-seminoma 9例であった.seminomaの2例ではsyncytiotrophoblastic giant cells (STGC)を確認した.病期はseminomaでは1が2例, 2が3例, 3が2例であり, non-seminomaでは1が4例, 2が2例, 3が3例であった.全例に除睾術を行っている.化学療法はPVB療法を主体とし, 症例によってはPV療法またはCDDP単独療法, CDDP+VP-16併用療法を施行した.seminomaの7例中6例に放射線治療を施行した.non-seminomaの1例も左鎖骨上窩腫瘤に対し放射線治療を行った.14例が癌なし生存であり, 期間は1年2ヵ月から7年6ヵ月(平均35.4±24.6ヵ月)であった.死亡はnon-seminomaの2例で, 1例は1年10ヵ月で癌死, 1例は4ヵ月で化学療法による骨髄不全にて死亡した, The clinical value of serum ferritin level in patients with testicular cancer was studied. Seven cases of seminoma and nine cases of non-seminoma from 1983 to 1989 were evaluated. The serum levels of ferritin, human chorionic gonadotropin (beta-HCG), alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA) and lactate dehydrogenase (LDH) were estimated before and after treatment. Abnormally high values of serum ferritin before treatment were noted in 4/7 (57%) in seminoma, 3/9 (33%) in non-seminoma and 7/16 (44%) in total. The total rate showing abnormally high values of serum ferritin was lower than that of beta-HCG and LDH. Meanwhile it was the same as that of AFP and higher than that of CEA. Changes in the serum ferritin level did not always correspond with the clinical course. In 3 out of 6 tumor free patients, higher levels of serum ferritin before treatment became normal after treatment. In one patient with a high level of serum ferritin before treatment, the level of serum ferritin remained higher and retroperitoneal lymph node metastasis developed after treatment. In 9 cases with normal serum ferritin level, 7 showed the normal range of ferritin level throughout the treatment course. These findings suggests that in some patients with testicular cancer, the serum ferritin level might serve as a tumor marker indicating the efficacy of the treatment and the tumor recurrence.

1)再燃前立腺癌82例に対する化学療法の効果をみるため新しく提唱した方法(泌尿器科紀要・投稿中)に基づき評価を行った.2)前立腺局所, 骨転移, 軟部組織転移, PAPの4項目を個別に評価し, それを合算して総合評価を行ったところ, PRとstableをそれぞれ19%および27%に認め, 両者は有意な生存期間の延長をみた.3)前立腺局所と骨転移は測定方法が鋭敏なものでないため, 総合評価との一致率が低かった.4)軟部組織とPAPは治療効果を鋭敏に反映した.特にPAPは異常値からの正常化が生存期間を延長する要因として認められた.5)化学療法により自覚症状が改善されることが多いが, 他覚的所見の総合評価とはかならずしも一致しないことが多かった.6)治療効果に影響を及ぼすものとして, 既治療の内容, performance state, 年齢, 病変数, stageがあったが, 初回治療時の組織学的分化度は関係がなかった.7)新しく提唱された評価方法の妥当性が認められた, Effect of chemotherapy for relapse of prostatic cancer was evaluated with new response criteria, in which four objective parameters including the prostate, bone metastasis, soft tissue metastasis and the serum acid phosphatase level estimated by radioimmunoassay or enzyme immunoassay were judged separately and then summarized to evaluate the response as complete response (CR), partial response (PR), stable and progressive disease (PD). Eighty-two patients were included in the study. Rate of PR and stable were 19% and 27%, respectively, and these two groups showed longer survival than those with PD. Evaluation of prostate and bone showed tendency to be discrepant with total judgement. Evaluation of soft tissues and prostatic acid phosphatase reflected the effect of chemotherapy. Chemotherapy often improved subjective symptoms but the effect did not parallel the total judgement in many cases. Factors influencing response of chemotherapy were mode of pretreatment, performance status, age, number of affected areas and clinical stage, but the grade at initial treatment was not correlated to response. The new criteria used in this study was valid for evaluation of response in prostatic cancer.

1981年1月1日から5年間に当院を訪れた前立腺癌の新来患者74例の集計を行った.1)初診時年齢の平均は72.2±7.7歳であり, 65歳から85歳までが87.9%を占めた.2)主訴は, 排尿困難(75.7%), 頻尿(52.7%)が多かった.3)進行癌(病期C, D)が70%を占めた.4)初回治療法としては, 内分泌療法が88.9%(64/72例)であり, エストロゲン療法とLH-RHアナログ単独療法の割合は1.7:1であった.5)初回内分泌療法施行例の21.9%(14/64例)は再燃・増悪で治療を中断した.6)病理組織学的には, 低分化型が約半数をしめた.7) 5年間の経過観察中, 確認できた死亡例は22例(29.7%)であった.うち前立腺癌死は全体の12.1%(9/74例)であった, Seventy-four new cases of prostatic carcinoma treated between 1981 and 1985 were analyzed. The patients were between 40 and 86 years old with a mean age of 72.2 +/- 7.7 years. More than 70% of the patients had clinical stage C and D carcinoma. All cases proved histologically to be adenocarcinoma of the prostate. Eighteen patients had well differentiated, 21 moderately differentiated and 35 poorly differentiated adenocarcinoma. Various hormonal treatments were performed as the initial treatment in 88.9% (64/72) of the cases. Among them, 37 cases were treated by estrogen and 22 cases by luteinizing hormone releasing hormone analogues. Fourteen of 64 patients (21.9%) who received hormonal treatment discontinued the therapy within 10.1 +/- 9.1 months because of relapse of the disease or no therapeutic response. Salvage therapy following hormonal treatment were chemotherapy (9/14) and radiation therapy (4/14). During the 5-year follow up 12.1% (9/74) of the patients died due to prostatic carcinoma.

An 82-year-old man was seen with the complaints of gross hematuria and dysphagia in September 1979. An invasive bladder tumor was found and TUR-Bt (Transitional cell carcinoma, G2, pT3NXMO ) was performed. Fluoroscopic examination revealed a large esophageal cancer (Undifferentiated squamous cell carcinoma, T2NXMO ) and irradiation was performed (Linac 4, 600 rads). The patient's condition aggravated rapidly and he died in February 1980. A 76-year-old man irradiated for an esophageal cancer (Linac 6, 540 rads) (undifferentiated squamous cell carcinoma, T1NXMO ) in March 1981. Eleven months later, bladder cancer was found and treated with TUR-Bt (Transitional cell carcinoma, G2, PTlmNXMO ) followed by intravesical instillation of carboquone and adriamycin. The patient was alive 1 year and 9 months after the diagnosis of the esophageal cancer. Sixteen cases of double cancer of the esophagus and urinary bladder were found in the Japanese literature. Eighteen cases including the above 2 cases were males and their ages ranged from 51 to 82 years. Sixteen bladder cancers were transitional cell carcinoma and 15 esophagus cancers were squamous cell carcinoma. Of 9 cases whose clinical course were described in detail, 3 were synchronous and 6 were metachronous. Radical surgery was performed for one or both of the two cancers in 5 cases, 4 of which were metachronous. Indication of surgery for the metachronous second cancer does not differ significantly from sporadic cancer when the first cancer has been managed successfully. However, the treatment for the synchronous double cancer of this type of combination is often forced to be restricted, since the prognosis of esophageal cancer is poor and surgical risk may be increased by two radical surgeries in such elderly patients.

The efficacy of cytotoxic agents in the treatment of prostatic cancer is difficult to evaluate because objective, measurable lesions, such as lung, liver, skin, subcutaneous and nodal metastasis are often not found. However, most of the patients with advanced prostatic cancer have bone involvement and elevated serum acid-phosphatase in addition to the primary tumor. Exact clinical trials on such cases, especially phase II studies can not be performed without appropriate evaluations of these three parameters. The criteria of these three parameters offered by various study groups are reviewed and the relevant response criteria are proposed. A stable category was thought to be useful to evaluate the efficacy on the patients with progressing disease. In our proposal, overall assessment of response involves all objective parameters including these three parameters as well as both measurable and unmeasurable disease described in the WHO handbook for reporting results of cancer treatment.

9施設565例の初診時年齢は70歳代をピークとする分布を示した.来院時症状は排尿困難が72.2%と最も多く, 癌性疼痛を訴える例が13.6%あった.検査法では, アルカリ性ホスファターゼ, 前立腺生検, IVP, 骨シンチグラフィー, 尿道膀胱造影, 前立腺酸性ホスファターゼ, 酸性ホスファターゼなどが広く施行されていた.臨床病期では, A1 6.2%, A2 3.7%, B 14.9%, C 20.7%, D1 7.4%, D2 43.7%であり, 進行病期のものが多かった.組織学的分化度は, 高, 中, 低分化癌が, それぞれ20.4%, 33.3%, 32.7%であった.初診時年齢が低いほど, 分化度の低い癌がやや多くなる傾向がみられた.また進行病期のものほど, 低分化癌の占める割合が増加していた.治療として内分泌療法が多く行われ, 方法としてほぼ全例にホルモン剤が投与され, その約半数に除睾術が併用された.臨床病期や組織学的分化度を考慮し, 手術療法, 放射線療法, 化学療法や複数の治療を組み合わせた治療法もある程度は試みられていたが, 年齢による制約がみられた.臨床病期別実測5年生存率は, 病期A1 89.2%, A2 66.1%, B 72.7%, G 51.0%, D1 47.5%, D2 28.0%であった.D2において低分化癌の実測5年生存率は16.0%であり, 高中分化癌より悪かった, Five hundred and sixty-five patients with prostatic cancer, who first visited 9 institutions in Japan between 1981 and 1985, were analyzed. The peak of age distribution was in the seventies. As clinical symptoms, disturbance on micturition was the most frequent and pain caused by metastasis was a complaint in approximately one tenth of the cases. Alkaline phosphatase measurement, prostatic biopsy, intravenous pyelography, bone scintigraphy, cystourethrography, and measurements of serum prostatic acid phosphatase and serum acid phosphatase were performed on more than 80% of the patients. The clinical stage was stage A1 in 6.2%, A2 in 3.7%, B in 14.9%, C in 20.7%, D1 in 7.4%, and D2 in 43.7%. According to the histological grade, well, moderately and poorly differentiated adenocarcinoma were observed in 20.4, 33.3 and 32.7%, respectively. Increased ratio of high grade to low grade was noticed in the lower age group as well as in the advanced stage. In this series, endocrine therapy was still accepted in most of the patients. Almost all were treated with hormonal medication and half of them had undergone bilateral orchiectomy. Surgery, radiation, chemotherapy or multidisciplinary therapy were attempted judging from the clinical stage and histological grade. However, old age restricted the therapeutic modality. Actuarial survival rate at 5 years for stage A1, A2, B, C, D1 and D2 was 89.2, 66.1, 72.7, 51.0, 47.5 and 28.0%, respectively. In the patients with stage D2, the 5-year actuarial rate of poorly differentiated adenocarcinoma was lower than that of well or moderately differentiated adenocarcinoma, even though more intensive therapy was given to the former.