Department of Molecular Medicine and Surgery, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden.
Department of Medicine/Huddinge Karolinska Institutet and ANOVA, Karolinska University Hospital, Stockholm, Sweden.
Eur J Surg Oncol. 2020 Jan;46(1):98-104. doi: 10.1016/j.ejso.2019.07.023. Epub 2019 Jul 19.
The aim of this study is to analyze postoperative adverse events (AE) in relation to acute primary testicular failure after radiotherapy (RT) for rectal cancer.
This relation was assessed in 104 men, included in a previous prospective cohort study of men treated with surgical resection of the rectum for rectal cancer stage I-III. Postoperative AE were graded according to Clavien-Dindo (2004). Grade 3 or more was set as cut-off for severe postoperative AE. The impact of primary testicular failure on postoperative AE was related to the cumulative mean testicular dose (TD) and the change in Testosterone (T) and Luteinizing hormone (LH) sampled at baseline and after RT.
Twenty-six study participants (25%) had severe postoperative AE. Baseline characteristics and endocrine testicular function did not differ significantly between groups with (AE+) and without severe postoperative AE (AE-). After RT, the LH/T-ratio was higher in AE+, 0.603 (0.2-2.5) vs 0.452 (0.127-5.926) (p = 0.035). The longitudinal regression analysis showed that preoperative change in T (OR 0.844, 95% CI 0.720-0.990, p = 0.034), LH/T-ratio (OR 2.020, 95% CI 1.010-4.039, p = 0.047) and low T (<8 nmol/L, OR 2.605, 95 CI 0.951-7.139, p = 0.063) were related to severe postoperative AE.
Preoperative decline in T due to primary testicular failure induced by preoperative RT could be a risk factor regarding short-term outcome of surgery in men with rectal cancer.
本研究旨在分析直肠癌放疗后急性原发性睾丸衰竭与术后不良事件（AE）的关系。
该研究纳入了 104 名男性患者，这些患者均在直肠癌 I-III 期接受了直肠切除术治疗，他们参与了之前的前瞻性队列研究。术后 AE 按照 Clavien-Dindo（2004）分级进行评估。将 3 级或以上的 AE 设为严重术后 AE 的截止值。原发性睾丸衰竭对术后 AE 的影响与累积平均睾丸剂量（TD）以及 RT 前后基线时采样的睾酮（T）和黄体生成素（LH）的变化有关。
26 名研究参与者（25%）发生严重术后 AE。有严重术后 AE（AE+）和无严重术后 AE（AE-）两组的基线特征和内分泌睾丸功能无显著差异。RT 后，AE+组的 LH/T 比值较高，为 0.603（0.2-2.5），而 AE-组为 0.452（0.127-5.926）（p=0.035）。纵向回归分析显示，术前 T 的变化（OR 0.844，95%CI 0.720-0.990，p=0.034）、LH/T 比值（OR 2.020，95%CI 1.010-4.039，p=0.047）和低 T（<8 nmol/L，OR 2.605，95%CI 0.951-7.139，p=0.063）与严重术后 AE 相关。
术前 RT 引起的原发性睾丸衰竭导致的 T 下降可能是直肠癌男性患者手术短期结局的一个危险因素。
