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雄激素剥夺治疗后局限性前列腺癌的睾酮恢复:两项随机试验的长期数据。

Testosterone recovery after androgen deprivation therapy in localised prostate cancer: Long-term data from two randomised trials.

机构信息

Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada.

Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada.

出版信息

Radiother Oncol. 2024 Jun;195:110256. doi: 10.1016/j.radonc.2024.110256. Epub 2024 Mar 27.

Abstract

BACKGROUND AND PURPOSE

To determine the rate and time of testosterone (T) recovery in patients (pts) with localised prostate cancer treated with radiotherapy plus 0-, 6-, 18- or 36-month of androgen deprivation therapy (ADT).

MATERIALS AND METHODS

In 1230 pts with prostate cancer randomised into two phase III trials, serum T was measured at baseline, then regularly. T recovery rate was compared between normal vs. abnormal baseline T and with ADT duration with Chi-square test or Fisher's exact test. A multivariable logistic regression model to predict the probability of recovering normal T was performed.

RESULTS

Overall, 87.4 % (167/191), 75.9 % (293/386), 54.8 % (181/330) and 43.2 % (80/185) of pts, recovered normal T on the 0-, 6-, 18- or 36-month schedule, respectively (p < 0.001). In patients recovering normal T, the median time to T recovery increased with ADT duration ranging from 0.31, 1.64, 3.06 to 5.0 years for the 0-, 6-, 18- or 36-month schedules, respectively (p < 0.001) and was significantly faster for those with a normal T at baseline (p < 0.001). On multivariable analysis, older age and longer ADT duration are associated with a lower T recovery.

CONCLUSIONS

Testosterone recovery rate after ADT depends on several factors including hormonal duration, normal baseline T, age and medical comorbidities. A longer ADT duration is the most important variable affecting T recovery. The data from this report might be a valuable tool to help physicians and patients in evaluating risks and benefits of ADT.

摘要

背景与目的

评估接受放疗联合 0 个月、6 个月、18 个月或 36 个月雄激素剥夺治疗(ADT)的局限性前列腺癌患者的睾酮(T)恢复率和时间。

材料与方法

1230 例前列腺癌患者随机分为两项 III 期临床试验,基线时及此后定期检测血清 T。采用卡方检验或 Fisher 确切概率法比较正常与异常基线 T 及 ADT 持续时间之间的 T 恢复率。采用多变量逻辑回归模型预测恢复正常 T 的概率。

结果

总体而言,167/191(87.4%)、293/386(75.9%)、181/330(54.8%)和 80/185(43.2%)患者分别在 0 个月、6 个月、18 个月和 36 个月时恢复正常 T(p<0.001)。在恢复正常 T 的患者中,T 恢复的中位时间随 ADT 持续时间而增加,分别为 0.31 年、1.64 年、3.06 年和 5.0 年(p<0.001),且基线 T 正常的患者恢复更快(p<0.001)。多变量分析显示,年龄较大和 ADT 持续时间较长与 T 恢复率降低相关。

结论

ADT 后 T 恢复率取决于多种因素,包括激素持续时间、基线 T 正常、年龄和合并症。ADT 持续时间较长是影响 T 恢复的最重要因素。本报告中的数据可能是帮助医生和患者评估 ADT 风险和获益的有用工具。

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