Department of Urology, University Vita-Salute San Raffaele, Milan, Italy.
Cancer. 2011 Nov 15;117(22):5029-38. doi: 10.1002/cncr.26136. Epub 2011 Apr 14.
The objective of this study was to assess the association between preoperative circulating levels of 17β-estradiol (E₂) and high-grade prostate cancer (HGPCa) (Gleason grade ≥ 4 + 3) at the time patients underwent radical retropubic prostatectomy (RRP).
Serum total testosterone (tT), sex hormone-binding globulin (SHBG), and E₂ levels were measured the day before surgery (8-10 AM) in a cohort of 655 consecutive Caucasian- European patients who underwent RRP at a single institution. Logistic regression models were used to test the association between predictors (including age, body mass index, prostate-specific antigen [PSA], clinical tumor classification, biopsy Gleason sum, tT, SHBG, and E₂) and HGPCa. Serum E₂ was included in the model as both a continuous variable and a categorized variable (according to the most informative cutoff: 50 pg/mL).
Pathologic HGPCa was identified in 156 patients (23.8%). Patients with HGPCa had significantly higher PSA, clinical tumor classification, and biopsy Gleason sum than those without HGPCa (all P < .001). No other significant differences were observed between groups. At univariate analysis, continuously coded E(2) was not associated significantly with HGPCa (odds ratio [OR], 1.009; P = .25), whereas patients with E₂ levels ≥ 50 pg/mL had a 3.24-fold increased risk of HGPCa (P < .001). At multivariate analysis, E₂ was associated significantly with HGPCa both as a continuous predictor (OR, 1.02; P = .04) and as a categorical predictor (OR, 3.94; P < .001) after accounting for other variables. Conversely, tT and SHBG levels were not associated significantly with HGPCa.
E₂ was associated significantly with pathologic HGPCa, whereas SHBG and tT failed to demonstrate any association with HGPCa in patients who underwent RRP.
本研究旨在评估接受根治性前列腺切除术（RRP）的患者术前循环中的 17β-雌二醇（E₂）水平与高级别前列腺癌（HGPCa）（Gleason 评分≥4+3）之间的关联。
在一家医疗机构接受 RRP 的 655 例连续白种欧洲患者中，于手术前一天（上午 8-10 点）测量血清总睾酮（tT）、性激素结合球蛋白（SHBG）和 E₂水平。使用逻辑回归模型检验预测因子（包括年龄、体重指数、前列腺特异性抗原[PSA]、临床肿瘤分类、活检 Gleason 总和、tT、SHBG 和 E₂）与 HGPCa 之间的相关性。将血清 E₂ 作为连续变量和分类变量（根据最具信息量的截断值：50pg/ml）纳入模型。
156 例患者（23.8%）病理确诊为 HGPCa。与无 HGPCa 的患者相比，HGPCa 患者的 PSA、临床肿瘤分类和活检 Gleason 总和显著更高（均 P<0.001）。两组之间未观察到其他显著差异。在单变量分析中，连续编码的 E₂与 HGPCa 无显著相关性（比值比[OR]，1.009；P=0.25），而 E₂水平≥50pg/ml 的患者 HGPCa 风险增加 3.24 倍（P<0.001）。在多变量分析中，E₂与 HGPCa 显著相关，既是连续预测因子（OR，1.02；P=0.04），也是分类预测因子（OR，3.94；P<0.001），考虑到其他变量后。相反，tT 和 SHBG 水平与 HGPCa 无显著相关性。
E₂与病理 HGPCa 显著相关，而 SHBG 和 tT 在接受 RRP 的患者中与 HGPCa 无明显关联。
