Bandak M, Jørgensen N, Juul A, Vogelius I R, Lauritsen J, Kier M G, Mortensen M S, Glovinski P, Daugaard G
Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Department of Growth and Reproduction, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Andrology. 2016 May;4(3):382-8. doi: 10.1111/andr.12177. Epub 2016 Mar 24.
Results concerning treatment of Testicular Germ Cell Cancer (TGCC) and subsequent risk of testosterone deficiency are conflicting. To systematically evaluate and estimate the risk of testosterone deficiency (TD) in TGCC-patients according to treatment to optimize follow-up and for prevention of late effects related to hypogonadism. We performed a critical review of PubMed in January 2015 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Twelve publications were selected for inclusion in this analysis. Eleven studies evaluated the risk of TD in TGCC-patients treated with standard chemotherapy (CT) and the odds ratio for TD was 1.8 (95% CI) (1.3-2.5), (p = 0.0007). Seven studies evaluated the risk of TD in TGCC-patients treated with non-conventional therapy and the odds ratio for TD was 3.1 (95% CI) (2.0-4.8), (p < 0.0001). Six studies evaluated the risk of TD in TGCC-patients treated with infradiaphragmatic radiotherapy (RT), and the odds ratio for TD was 1.6 (95% CI) (1.0-2.4), (p = 0.03). In all treatment groups the risk of TD was compared with TGCC-patients treated with orchiectomy alone. There was no indication of heterogeneity between studies in the three treatment groups. Strong evidence exists that standard CT, non-conventional therapy and infradiaphragmatic RT are associated with an increased risk of TD in TGCC-patients when compared with orchiectomy alone. The risk of testosterone defficiency appears to be highest in patients treated with non-conventional therapy.
关于睾丸生殖细胞癌（TGCC）的治疗结果以及随后出现睾酮缺乏症的风险，相关研究结果存在矛盾。为了根据治疗方法系统评估和估计TGCC患者睾酮缺乏症（TD）的风险，以优化随访并预防与性腺功能减退相关的晚期影响。我们于2015年1月根据系统评价和Meta分析的首选报告项目（PRISMA）声明对PubMed进行了严格审查。选择了12篇出版物纳入本分析。11项研究评估了接受标准化疗（CT）的TGCC患者发生TD的风险，TD的优势比为1.8（95%CI）（1.3 - 2.5），（p = 0.0007）。7项研究评估了接受非常规治疗的TGCC患者发生TD的风险，TD的优势比为3.1（95%CI）（2.0 - 4.8），（p < 0.0001）。6项研究评估了接受膈下放疗（RT）的TGCC患者发生TD的风险，TD的优势比为1.6（95%CI）（1.0 - 2.4），（p = 0.03）。在所有治疗组中，将TD的风险与仅接受睾丸切除术的TGCC患者进行了比较。三个治疗组的研究之间没有异质性迹象。有强有力的证据表明，与仅接受睾丸切除术相比，标准化疗、非常规治疗和膈下放疗与TGCC患者发生TD的风险增加相关。接受非常规治疗的患者中睾酮缺乏症的风险似乎最高。
