泌尿***癌における腫瘍マーカー : hCG,AFP,Prostatic serum acid phosphatase(PSAP),CEA,β2 Microglobulin(β2 MG)
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Serum hCG and AFP for testicular germ cell tumors, PSAP for prostatic carcinoma, and serum CEA and β2MG for urogenital malignancies were measured by radioimmunoassay (RIA) techniques. 1. Specific tumor marker 1) hCG and AFP: AFP was detected in embryonal carcinoma (EG), infantile EC and teratocarcinoma (TC). AFP and/or hCG was detected in the mixed type of tumor consisting of EC, TC and choriocarcinoma. This was dependent on the major histological component of the tumor. Even in the pure seminoma, elevation of hCG was noted in 4 out of 17 cases, followed by normalization after orchiectomy. Alteration of AFP and hCG well demonstrated an effect of treatment and clinical courses. Reelevation of the markers revealed an advance of clinical staging and recurrence of the tumor. 2) PSAP: Serum levels of PSAP by RIA method correlated well with those by enzyme method, however, the former showed pseudonegative values less than the latter. Elevation of PSAP gave a clue to the initial diagnosis and to earlier detection of recurrence of prostatic carcinoma. 2. Nonspecific tumor marker 1) Beta-2-MG: Since the elevation of β2MG primarily reflects a decrease in the renal function, relationship between creatinine clearance (GFR) and β2MG in noncancerous patients with a variety of renal function was applied to the cancer patients and such a functional factor to increase serum level of , β2MG was excluded. Elevation of β2MG was seen in patients with advanced stage of urogenital malignancies. Such a rate of elevation was 62.5% in testicular carcinoma, 55.6% in renal cell carcinoma, 48.1 % in bladder carcinoma, 45.5% in pelvic and ureteral tumors and 22.2% in prostatic carcinoma. Beta-2-MG increased in 46.9% of advanced urogenital cancers as a whole. 2) CEA: CEA also elevated in the advanced stage of urogenital cancers, although its percentage was less than that in β2MG. Elevation of CEA was detected in 44.4% of prostatic carcinomas, 37.0% of bladder carcinomas, 36.4% of pelvic and ureteral tumors and 22.2% of renal cell carcinomas. None of testicular carcinoma revealed an abnormal CEA value. 3) Combination of β2MG and/or CEA did not raise positive rates of the markers in each of urogenital cancers. However, when those patients were divided into 3 groups such as "Alive" with no evidence of disease, "Alive" with disease and "Dead", according to the survival states, elevation of β2MG or β2MG and CEA was seen in patients in whom tumorous lesions were not eliminated or recurrence was noticed, indicating a poor prognosis. In conclusion, to estimate AFP and hCG or PSAP, as a specific tumor marker, andβ2MG and/or CEA, as a nonspecific tumor marker, is a useful adjunct to detect clinical courses and to predict prognosis of urogenital malignancies.
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