Lee Jung Keun, Byun Seok-Soo, Lee Sang Eun, Hong Sung Kyu
From the Department of Urology, Seoul National University of Hospital, Seoul (JKL); and Department of Urology, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea (S-SB, SEL, SKH).
Medicine (Baltimore). 2015 Jul;94(28):e1185. doi: 10.1097/MD.0000000000001185.
To investigate the significance of preoperative serum sex hormone-binding globulin (SHBG) level regarding the postoperative biochemical outcome in patients who were followed up for relative longer periods after undergoing radical prostatectomy (RP). Preoperative serum levels of testosterone (T), free T, and SHBG level were prospectively analyzed in 307 consecutive patients who underwent RP at our institution between January 2006 and July 2007. We analyzed potential associations of sex hormones with postoperative biochemical recurrence (BCR)-free survival via multivariate Cox proportional regression analysis. Mean postoperative follow-up duration for 307 total patients was 72.1 ± 19.6 months. Kaplan-Meier curve demonstrated that BCR-free survival was significantly worse in patients with higher (≥ 40 ng/mL) SHBG level than others (P < 0.001). Serum T (P = 0.280) and free T (P = 0.606) levels showed no significant association with biochemical outcome. In multivariate analysis encompassing postoperative variables along with PSA, T, and free T, SHBG level (HR 1.825, 1.061-3.138; P = 0.030) was observed to be independently associated with BCR-free survival. Addition of SHBG level to the multivariate model for prediction of BCR-free survival resulted in increased accuracy (83.5% vs. 82.2%; P = 0.164). Our study of patients who were followed up for relative longer periods after RP shows that preoperative serum SHBG level, but not T, is an independent predictor of postoperative BCR-free survival. According to our findings, SHBG measurement may be useful in the selection of candidates for adjuvant treatment following RP.
为了研究术前血清性激素结合球蛋白（SHBG）水平对于接受根治性前列腺切除术（RP）后随访时间相对较长的患者术后生化结果的意义。对2006年1月至2007年7月在本机构连续接受RP的307例患者术前血清睾酮（T）、游离T和SHBG水平进行了前瞻性分析。我们通过多变量Cox比例回归分析来分析性激素与术后无生化复发（BCR）生存之间的潜在关联。307例患者的平均术后随访时间为72.1±19.6个月。Kaplan-Meier曲线显示，SHBG水平较高（≥40 ng/mL）的患者无BCR生存明显差于其他患者（P<0.001）。血清T（P=0.280）和游离T（P=0.606）水平与生化结果无显著关联。在包含术后变量以及PSA、T和游离T的多变量分析中，观察到SHBG水平（HR 1.825，1.061-3.138；P=0.030）与无BCR生存独立相关。将SHBG水平添加到预测无BCR生存的多变量模型中可提高准确性（83.5%对82.2%；P=0.164）。我们对RP后随访时间相对较长的患者的研究表明，术前血清SHBG水平而非T是术后无BCR生存的独立预测因素。根据我们的研究结果，SHBG检测可能有助于RP后辅助治疗候选者的选择。
