Shinoda I
Department of Urology, School of Medicine, Gifu University.
Nihon Gan Chiryo Gakkai Shi. 1990 Nov 20;25(11):2627-39.
To evaluate the usefulness of tumor markers in monitoring the patients with prostate cancer, serial measurements of serum prostate-specific antigen (PA), prostatic acid phosphatase (PAP) and gamma-seminoprotein (gamma-Sm) were performed in 78 stage C or D patients. Positive rates of each marker prior to the treatment were as follows; PA; 75%, PAP; 56% and gamma-Sm; 62% in stage C, and PA; 95%, PAP; 79% and gamma-Sm; 91% in stage D. In most cases showing PR (partial response) and S (stable) in clinical responses, these three markers decreased their serum titers corresponding to clinical course if the markers were elevated at the start of the treatment. But the usefulness of PAP was lessened because of its lower positive rate than those of PA and gamma-Sm. In 33 PD (progressive disease) cases, positive rates of each marker at time of clinical diagnosis as PD were found to be 85% in PA, 55% in PAP and 76% in gamma-Sm. And with the combination assays of these three tumor markers, positive rate was elevated to 88%. Moreover, elevation of serum values of these three markers at 3 months before the progression event were observed in 50% of PA, 39% of PAP and 46% of gamma-Sm. Then the prognostic significance of each marker was examined. In PA and PAP, there were statistical differences in non-relapsing rates between patients whose reduction rates from the pretreatment value on 7th day were more than and less than 50%. But in gamma-Sm, a statistical difference between each group was firstly observed on 14th day. As a result, in monitoring patients with prostate cancer, PA and gamma-Sm are more useful than PAP and, in prediction of patients' prognosis, PA is more useful than gamma-Sm.
为评估肿瘤标志物在监测前列腺癌患者中的作用,我们对78例C期或D期患者进行了血清前列腺特异性抗原(PA)、前列腺酸性磷酸酶(PAP)和γ-精浆蛋白(γ-Sm)的系列检测。治疗前各标志物的阳性率如下:C期患者中,PA为75%,PAP为56%,γ-Sm为62%;D期患者中,PA为95%,PAP为79%,γ-Sm为91%。在大多数临床反应显示PR(部分缓解)和S(病情稳定)的病例中,如果这些标志物在治疗开始时升高,那么随着临床病程的发展,这三种标志物的血清滴度会相应降低。但由于PAP的阳性率低于PA和γ-Sm,其作用有所减弱。在33例PD(疾病进展)病例中,临床诊断为PD时各标志物的阳性率分别为:PA为85%,PAP为55%,γ-Sm为76%。而这三种肿瘤标志物联合检测时,阳性率提高到了88%。此外,在病情进展事件前3个月,观察到50%的PA、39%的PAP和46%的γ-Sm血清值升高。然后我们研究了各标志物的预后意义。在PA和PAP中,第7天较治疗前值降低率大于和小于50%的患者,其无复发率存在统计学差异。但在γ-Sm中,各分组之间的统计学差异首先在第14天观察到。结果表明,在监测前列腺癌患者时,PA和γ-Sm比PAP更有用;在预测患者预后方面,PA比γ-Sm更有用。