Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
J Urol. 2018 Oct;200(4):794-800. doi: 10.1016/j.juro.2018.04.077. Epub 2018 May 3.
Evidence on the long-term impact of testicular cancer treatment on sexual function is not clear. Our aim was to estimate the effect of testicular cancer treatment on the risk of sexual dysfunction in long-term survivors of testicular cancer.
We performed a cross-sectional study of 2,260 long-term survivors of testicular cancer with a median followup of 17 years (IQR 12-24), including 1,098 who underwent orchiectomy alone (surveillance), 788 treated with bleomycin, etoposide and cisplatin alone or post-chemotherapy retroperitoneal surgery, 300 treated with abdominal radiotherapy and 74 who received more than 1 line of treatment. Sexual function was evaluated by the IIEF-15 (International Index of Erectile Function-15) questionnaire. Results were compared between treatment groups using logistic regression analysis with the results on each of the 5 IIEF-15 dimensions as the outcome and treatment as exposure using surveillance as the referent.
The risk of erectile dysfunction was increased in all treatment groups compared to surveillance, including bleomycin, etoposide and cisplatin alone (OR 1.5, 95% CI 1.0-2.1, p <0.05), bleomycin, etoposide and cisplatin with post-chemotherapy surgery (OR 2.1, 95% CI 1.4-3.4, p <0.005), radiotherapy (OR 1.7, 95% CI 1.1-2.5, p <0.05) and more than 1 line of treatment (OR 3.2, 95% CI 1.6-6.3, p <0.005). Orgasmic dysfunction was associated with radiotherapy, bleomycin, etoposide and cisplatin with post-chemotherapy surgery and more than 1 line of treatment.
Treatment with bleomycin, etoposide and cisplatin, radiotherapy and more than 1 treatment line increased the risk of erectile dysfunction in long-term survivors of testicular cancer compared to surveillance. Patients should be informed about this as part of the information on treatment related late effects.
关于睾丸癌治疗对性功能的长期影响的证据尚不清楚。我们的目的是评估睾丸癌治疗对长期生存的睾丸癌患者发生性功能障碍的风险的影响。
我们对 2260 名睾丸癌长期幸存者进行了一项横断面研究，中位随访时间为 17 年（IQR 12-24），其中 1098 名接受了单纯睾丸切除术（监测），788 名接受了博来霉素、依托泊苷和顺铂单独或化疗后腹膜后手术治疗，300 名接受了腹部放疗，74 名接受了超过 1 线治疗。通过 IIEF-15（国际勃起功能指数-15）问卷评估性功能。使用逻辑回归分析比较治疗组之间的结果，将每个 IIEF-15 维度的结果作为结局，将治疗作为暴露因素，以监测作为参考。
与监测组相比，所有治疗组的勃起功能障碍风险均增加，包括博来霉素、依托泊苷和顺铂单独治疗（OR 1.5，95%CI 1.0-2.1，p<0.05）、博来霉素、依托泊苷和顺铂联合化疗后手术（OR 2.1，95%CI 1.4-3.4，p<0.005）、放疗（OR 1.7，95%CI 1.1-2.5，p<0.05）和超过 1 线治疗（OR 3.2，95%CI 1.6-6.3，p<0.005）。射精功能障碍与放疗、博来霉素、依托泊苷和顺铂联合化疗后手术和超过 1 线治疗有关。
与监测相比，博来霉素、依托泊苷和顺铂、放疗和超过 1 线治疗增加了长期生存的睾丸癌患者发生勃起功能障碍的风险。患者应了解这一点，作为治疗相关晚期效应信息的一部分。
