Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark.
Department of Growth and Reproduction, Copenhagen University Hospital, Rigshospitalet, Denmark; International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Denmark.
Eur Urol Focus. 2018 Jul;4(4):591-598. doi: 10.1016/j.euf.2016.11.018. Epub 2016 Dec 15.
Controversy exists whether Leydig cells recover after testicular cancer (TC) treatment or whether premature hormonal aging will occur.
Evaluate serial changes in total testosterone (TT) and luteinizing hormone (LH) in patients treated with orchiectomy alone (Stage I) or combination chemotherapy with bleomycin, etoposide, and cisplatin (BEP).
DESIGN, SETTINGS, AND PARTICIPANTS: Changes in TT and LH were investigated during 5-yr follow-up (Stage I: n=75, BEP: n=81). A selected group of TC patients with mild Leydig cell dysfunction (LH ≥ 8 IU/l) were followed for a longer period (Stage I: n=20, BEP: n=23). An age-matched control group of 839 healthy men served as controls for TT and LH levels.
Changes in age-adjusted TT and LH were evaluated separately in each treatment group with univariate linear regression analysis. The proportion of patients initiating testosterone substitution during follow-up was calculated.
In the 75 Stage I patients there were no significant changes in LH and TT, while in the 81 BEP treated patients there was a significant decline in LH during follow-up (-24.2 percentage point/yr, 95% confidence interval: -38.5 to -9.9, p=0.001). In total, 11% of Stage I patients and 15% of BEP-treated patients initiated testosterone substitution. In the 23 BEP-treated patients with mild Leydig cell dysfunction there was a significant decline in age-adjusted TT (-0.9 percentage point/yr, 95% confidence interval: -1.8 to -0.04, p=0.04), while in the 20 Stage I patients there were no significant changes in age-adjusted LH and TT. Limitations include the retrospective study design.
TT remained stable during 5-yr follow-up in TC patients treated with orchiectomy alone or BEP. BEP-treated patients with mild Leydig cell dysfunction during follow-up were at risk of long-term testicular failure and evaluation of Leydig cell function beyond follow-up should be considered in this group of patients.
This study shows that the majority of testicular cancer survivors had stable testosterone levels after treatment for testicular cancer. However, 11-15% of patients needed testosterone substitution after treatment.
关于睾丸癌（TC）治疗后是否会恢复间质细胞功能，或者是否会发生过早的激素衰老，存在争议。
评估单纯睾丸切除术（I 期）或博来霉素、依托泊苷和顺铂联合化疗（BEP）治疗的患者中总睾酮（TT）和黄体生成素（LH）的连续变化。
设计、地点和参与者：在 5 年随访期间（I 期：n=75，BEP：n=81）研究了 TT 和 LH 的变化。选择一组间质细胞功能轻度障碍（LH≥8IU/l）的 TC 患者进行了更长时间的随访（I 期：n=20，BEP：n=23）。839 名健康男性的年龄匹配对照组用于 TT 和 LH 水平的对照。
采用单变量线性回归分析分别评估每组患者的年龄调整后 TT 和 LH 的变化。计算了随访期间开始睾酮替代治疗的患者比例。
在 75 例 I 期患者中，LH 和 TT 无明显变化，而在 81 例 BEP 治疗患者中，LH 在随访期间明显下降（-24.2%/年，95%置信区间：-38.5 至-9.9，p=0.001）。共有 11%的 I 期患者和 15%的 BEP 治疗患者开始接受睾酮替代治疗。在 23 例有轻度间质细胞功能障碍的 BEP 治疗患者中，年龄调整后的 TT 明显下降（-0.9%/年，95%置信区间：-1.8 至-0.04，p=0.04），而在 20 例 I 期患者中，LH 和 TT 的年龄调整无明显变化。局限性包括回顾性研究设计。
在接受单纯睾丸切除术或 BEP 治疗的 TC 患者中，TT 在 5 年随访期间保持稳定。在随访期间有轻度间质细胞功能障碍的 BEP 治疗患者存在长期睾丸衰竭的风险，应考虑在这组患者中对间质细胞功能进行随访评估。
本研究表明，大多数睾丸癌幸存者在接受睾丸癌治疗后，其睾酮水平保持稳定。然而，治疗后 11-15%的患者需要进行睾酮替代治疗。
