雄激素剥夺治疗的持续时间以及睾酮水平最低点达到20 ng/dL，可预测接受外照射放疗的前列腺癌患者睾酮恢复至去势水平以上。
Duration of androgen deprivation therapy and nadir of testosterone at 20 ng/dL predict testosterone recovery to supracastrate level in prostate cancer patients who received external beam radiotherapy.
作者信息
Takei Akinori, Sakamoto Shinichi, Wakai Ken, Tamura Takaaki, Imamura Yusuke, Xu Minhui, Maimaiti Maihulan, Kawamura Koji, Imamoto Takashi, Komiya Akira, Akakura Koichiro, Ichikawa Tomohiko
机构信息
Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan.
Department of Urology, Japan Community Healthcare Organization Tokyo Shinjuku Medical Center, Tokyo, Japan.
出版信息
Int J Urol. 2018 Apr;25(4):352-358. doi: 10.1111/iju.13521. Epub 2018 Jan 11.
OBJECTIVES
To determine the predictors of testosterone recovery after termination of androgen deprivation therapy in high/intermediate-risk prostate cancer patients receiving external beam radiation therapy with neoadjuvant and adjuvant androgen deprivation therapy.
METHODS
A total of 82 patients who underwent external beam radiation therapy with androgen deprivation therapy for prostate cancer were retrospectively analyzed. Serum testosterone levels after androgen deprivation therapy terminations were studied. Cox proportional hazard models and the Kaplan-Meier method were used for statistical analysis.
RESULTS
Median age, baseline testosterone, nadir testosterone and duration of androgen deprivation therapy were 73 years, 456 ng/dL, 16 ng/dL and 26 months, respectively. Androgen deprivation therapy duration of 33 months (hazard ratio 0.13; P = 0.0018), nadir testosterone of 20 ng/dL (hazard ratio 0.35; P = 0.0112) and testosterone >50 ng/dL at 6 months after androgen deprivation therapy termination (hazard ratio 0.21; P = 0.0075) were significantly associated with testosterone recovery to normal levels (200 ng/dL) on multivariate analysis. Androgen deprivation therapy duration of 33 months (hazard ratio 0.31; P = 0.0023) and nadir testosterone of 20 ng/dL (hazard ratio 0.38; P = 0.0012) were significantly associated with testosterone recovery to the supracastrate level (50 ng/dL) on multivariate analysis. After dividing patients into three risk groups, the rate of testosterone recovery to the normal level after 2 years of androgen deprivation therapy termination was 100% in the low-risk group versus 20.8% in the high-risk group (P < 0.0001); the rate of testosterone recovery to the supracastrate level was 100% in the low-risk group versus 51.5% in the high-risk group (P < 0.0001).
CONCLUSIONS
Duration of androgen deprivation therapy and achievement of nadir testosterone 20 ng/dL both predict testosterone recovery to the supracastrate level in prostate cancer patients undergoing external beam radiation therapy with androgen deprivation therapy.
目的
确定接受新辅助和辅助雄激素剥夺治疗的高/中危前列腺癌患者在雄激素剥夺治疗终止后睾酮恢复的预测因素。
方法
回顾性分析82例接受前列腺癌雄激素剥夺治疗及外照射放疗的患者。研究雄激素剥夺治疗终止后的血清睾酮水平。采用Cox比例风险模型和Kaplan-Meier方法进行统计分析。
结果
患者的中位年龄、基线睾酮水平、最低睾酮水平和雄激素剥夺治疗持续时间分别为73岁、456 ng/dL、16 ng/dL和26个月。多因素分析显示，雄激素剥夺治疗持续33个月（风险比0.13；P = 0.0018）、最低睾酮水平为20 ng/dL（风险比0.35；P = 0.0112）以及雄激素剥夺治疗终止后6个月时睾酮>50 ng/dL（风险比0.21；P = 0.0075）与睾酮恢复至正常水平（200 ng/dL）显著相关。多因素分析显示，雄激素剥夺治疗持续33个月（风险比0.31；P = 0.0023）和最低睾酮水平为20 ng/dL（风险比0.38；P = 0.0012）与睾酮恢复至去势后水平（50 ng/dL）显著相关。将患者分为三个风险组后，雄激素剥夺治疗终止2年后，低风险组睾酮恢复至正常水平的比例为100%，而高风险组为20.8%（P < 0.0001）；低风险组睾酮恢复至去势后水平的比例为100%，而高风险组为51.5%（P < 0.0001）。
结论
雄激素剥夺治疗的持续时间以及最低睾酮水平达到20 ng/dL均能预测接受雄激素剥夺治疗及外照射放疗的前列腺癌患者睾酮恢复至去势后水平。
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