内分泌療法が施行された80歳以上の非転移性前立腺癌の検討

Clinical characteristics of non-metastatic prostate cancer treated with androgen deprivation therapy in elderly patients aged ≧ 80 years

　2000年1月〜2010年12月に80歳以上で非転移性前立腺癌と診断された症例のうち，内分泌療法が施行された82例を対象とし，併存疾患を含めて検討を行った．併存疾患はCharlson comorbidity index（CCI）を用いて評価した．年齢中央値83歳，診断時PSA中央値は18.2ng／mL，5年疾患特異的生存率（CSS）／全生存率は93％／78％であった．生検組織のGleason's sumが8以上の症例では8未満の症例と比較し，CSSは有意に低かった．全死亡に関しては，CCIが1以上であることが唯一の独立した有意な危険因子となった．80歳以上の高齢者において，CCIが1以上の症例は前立腺癌以外で命を落とす可能性が高く，前立腺癌の診断および治療は慎重に対応する必要があると思われた．

Abstract

Between January 2000 and December 2010, 82 patients, aged ≥ 80 years, with localized prostate carcinoma, who were treated with androgen deprivation therapy were retrospectively subjected to evaluation of survival rate and multivariate regression analysis. Comorbidities were measured from medical records using the Charlson comorbidity index (CCI). The mean age of the patients was 83 years, and the median pretreatment PSA level was 18.2ng/mL. The overall and cancer-specific survival rates were 78% and 93%, respectively. Cancer-specific survival rates were significantly lower in patients with Gleason's sums ≥ 8 than in patients with sums < 8. Between the two CCI score groups, overall survival rates differed significantly. During multivariate analysis, CCI ≥ 1 was an independent factor for poor prognosis. Among elderly patients with localized cancer, the probability of cancer-specific death was very low regardless of PSA levels and clinical T stages. Patients with one or more CCI were at high risk of death by other causes. Therefore, the diagnosis and treatment of prostate cancer in men aged ≥ 80 years should be carefully performed considering not only the potential risk of cancer malignancy but also the individual health conditions and comorbidities (Rinsho Hinyokika 70 : 265-270, 2016).