根治的前立腺全摘除術の臨床的検討

Clinical outcomes of patients underwent radical prostatectomy in Tane general hospital：Interim-term results

　1995年1月～2008年12月までに多根総合病院において根治的前立腺全摘除術を施行した133例を対象に，治療成績について臨床的検討を行った。さらに術前術後補助療法未施行の手術単独症例95例についてのPSA再発規定因子について検討した。観察期間中に癌死症例は認めず，全症例の5年全生存率は95.4％，5年PSA非再発率は67.9％であった。手術単独症例の5年PSA非再発率は60.4％であった。手術単独症例におけるPSA再発の独立した規定因子は，術前PSA値，生検時Gleason score，摘除標本における外科的切除断端陽性，精囊浸潤であった。以上により，切除範囲の工夫によって手術成績の改善が期待されると考えられた。

　Between January 1995 and December 2008,133 patients who underwent radical prostatectomy（RP） in Tane general hospital were enrolled to assess the interim-term clinical outcomes. We evaluated both estimated overall survival rate and biochemical recurrence free rate by using a Kaplan-Meier method. Furthermore predictors of biochemical recurrence in 95 patients without neoadjuvant and adjuvant therapy were assessed in univariate and multivariate analyses by Cox proportional hazards regression model. The 5-year overall survival rate and biochemical recurrence free rate were 95.4％ and 67.9％,respectively. The 5-year biochemical recurrence free rate in patients（n＝95）who underwent RP without neoadjuvant and adjuvant therapy was 60.4％. On multivariate analysis,preoperative serum prostate specific antigen（PSA）,Gleason score at biopsy,seminal vesicle invasion and positive surgical margin were independent risk factors of biochemical recurrence in patients without neoadjuvant and adjuvant therapy. Overall survival rate in patients who underwent RP showed excellent results. Positive surgical margin was an independent predictor of biochemical recurrence. The development of surgical technique to avoid positive surgical margin would be expected to achieve a higher recurrence free rate.