Ondrusova Martina, Spanikova Beata, Sevcikova Katarina, Ondrus Dalibor
1 St. Elisabeth University of Health and Social Science, Bratislava, Slovak Republic.
2 St. Elisabeth Cancer Institute, Bratislava, Slovak Republic.
Am J Mens Health. 2018 May;12(3):628-633. doi: 10.1177/1557988316661986. Epub 2016 Aug 3.
The aim of the study was to investigate the influence of therapeutic modalities and sexual hormone levels on changes in bone mineral density (BMD) in testicular cancer (TC) survivors. In a cross-sectional descriptive, long-term follow-up study, a total of 1,249 long-term TC survivors were evaluated according to treatment modality: orchiectomy (OE) only, OE + chemotherapy (CT), or OE + radiotherapy (RT). Luteinizing hormone (LH), total testosterone (TST), marker of bone resorption (β-carboxyl-terminal cross-linking telopeptide of type I collagen-CTx), and BMD were evaluated. Standard statistical techniques were used to test the differences between groups of patients. TST decrease was observed in 46/313 TC survivors after OE alone, in 103/665 after OE + CT, and in 66/271 after OE + RT. LH increase was observed in 23/313 TC survivors after OE alone, in 154/665 after OE + CT, and in 43/271 after OE + RT. CTx increase was observed in 116/313 TC survivors after OE alone, in 324/665 after OE + CT, and in 82/271 after OE + RT. Osteopenia/osteoporosis occurred in 136/313 TC survivors after OE alone, in 298/665 after OE + CT, and in 139/271 after OE + RT. TC survivors after RT have statistically significant decreased TST levels, increased LH and nonsignificant worse BMD (osteopenia/osteoporosis) in comparison with TC survivors after OE alone or CT. TST decrease and LH increase were statistically significant, more frequently observed in patients with osteopenia/osteoporosis. Examination of TST is an important part of follow-up in TC survivors with bilateral as well as unilateral disease. The important part of standard examination algorithm should be also the osteological examination of TC survivors mainly in patients with androgen deficiency.
本研究的目的是调查治疗方式和性激素水平对睾丸癌（TC）幸存者骨矿物质密度（BMD）变化的影响。在一项横断面描述性长期随访研究中，根据治疗方式对总共1249名长期TC幸存者进行了评估：单纯睾丸切除术（OE）、OE + 化疗（CT）或OE + 放疗（RT）。评估了促黄体生成素（LH）、总睾酮（TST）、骨吸收标志物（I型胶原β-羧基末端交联肽-CTx）和BMD。使用标准统计技术来检验患者组之间的差异。单纯OE后，46/313名TC幸存者出现TST降低；OE + CT后，103/665名出现TST降低；OE + RT后，66/271名出现TST降低。单纯OE后，23/313名TC幸存者出现LH升高；OE + CT后，154/665名出现LH升高；OE + RT后，43/271名出现LH升高。单纯OE后，116/313名TC幸存者出现CTx升高；OE + CT后，324/665名出现CTx升高；OE + RT后，82/271名出现CTx升高。单纯OE后，136/313名TC幸存者发生骨质减少/骨质疏松；OE + CT后，298/665名发生骨质减少/骨质疏松；OE + RT后，139/271名发生骨质减少/骨质疏松。与单纯OE或CT后的TC幸存者相比，RT后的TC幸存者TST水平有统计学意义的降低，LH升高，BMD（骨质减少/骨质疏松）虽无统计学意义但更差。TST降低和LH升高有统计学意义，在骨质减少/骨质疏松患者中更频繁观察到。对双侧以及单侧疾病的TC幸存者进行随访时，检测TST是重要的一部分。标准检查算法的重要部分还应包括对TC幸存者进行骨学检查，主要针对雄激素缺乏的患者。
