Higa T, Akimoto S, Isaka S, Shimazaki J, Goto S
Department of Urology, School of Medicine, Chiba University.
Nihon Hinyokika Gakkai Zasshi. 1991 May;82(5):734-43. doi: 10.5980/jpnjurol1989.82.734.
The clinical courses of bone metastases in 81 cases of prostatic cancer were examined using conventional X-ray. All patients received endocrine therapy as the initial treatment; castration and estrogen were given to 46 cases, castration and antiandrogen to 19, LH-RH analog to 11, flutamide to 5. The response to endocrine therapy was evaluated every 6 months after the start of the treatment according to National Prostatic Cancer Project criteria. The prognosis was calculated by cause-specific survival. The types of untreated bone metastases on X-ray were classified into five: sclerotic in 12 cases (15%), mixed but mainly sclerotic in 25 (31%), mixed but mainly lytic in 14 (17%), lytic in 8 (10%) and undetermined with positive scintigraphy in 22 (27%). Two mixed types showed more spread metastases and tendency of elevated prostatic acid phosphatase when compared with other types. Temporary enlargement of sclerotic area within 6 months after start of the treatment did not correlate with deterioration of disease. Remodeling of metastatic areas occurred 6-36 months after start of the treatment showed curative course and the prognosis of these groups were favorable. Most of lytic areas tended to sclerotic finding following endocrine therapy regardless of effects by endocrine therapy. Sclerotic and two mixed types showed better and worse tendencies, respectively. On viewpoint of remodeling, change of metastatic area and newly appearance of metastases, an evaluation criteria of response to the therapy was proposed, which showed good correlation with prognosis. From these observations, it was concluded that bone metastases tended from lytic to sclerotic changes and that lytic-sclerotic cycles occurred repeatedly along with disease progression regardless of effect to therapy. Remodeling seemed to be curative signs of metastatic area.
采用传统X线检查了81例前列腺癌骨转移患者的临床病程。所有患者均接受内分泌治疗作为初始治疗；46例患者接受去势和雌激素治疗，19例接受去势和抗雄激素治疗，11例接受促性腺激素释放激素（LH-RH）类似物治疗，5例接受氟他胺治疗。治疗开始后，每6个月根据国家前列腺癌项目标准评估内分泌治疗的反应。通过特定病因生存率计算预后。X线检查未治疗的骨转移类型分为五种：硬化型12例（15%），混合但以硬化为主型25例（31%），混合但以溶骨为主型14例（17%），溶骨型8例（10%），骨扫描阳性但未确定型22例（27%）。与其他类型相比，两种混合型显示出更多的转移灶扩散和前列腺酸性磷酸酶升高的趋势。治疗开始后6个月内硬化区域的暂时扩大与疾病恶化无关。治疗开始后6 - 36个月发生的转移区域重塑显示为治愈过程，这些组的预后良好。无论内分泌治疗效果如何，大多数溶骨区域在内分泌治疗后倾向于出现硬化表现。硬化型和两种混合型分别显示出较好和较差的趋势。从重塑、转移区域变化和新转移灶出现的角度，提出了治疗反应的评估标准，该标准与预后显示出良好的相关性。从这些观察结果得出结论，骨转移倾向于从溶骨改变转变为硬化改变，并且无论治疗效果如何，随着疾病进展，溶骨 - 硬化循环会反复发生。重塑似乎是转移区域的治愈迹象。
