Preorchiectomy Leydig Cell Dysfunction in Patients With Testicular Cancer.
Preorchiectomy Leydig Cell Dysfunction in Patients With Testicular Cancer.
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DOI：
10.1016/j.clgc.2016.07.006
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发表时间：
2017-02-01
影响因子：
3.2
通讯作者：
Daugaard, Gedske
中科院分区：
文献类型：
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作者：
Bandak, Mikkel;Jorgensen, Niels;Daugaard, Gedske
背景：对于睾丸生殖细胞癌（TGCC）患者睾丸切除术前睾丸间质细胞的功能知之甚少。目的是估计 TGCC 患者队列中睾丸切除术前 Leydig 细胞功能障碍的患病率，并评估与这种情况相关的因素。 患者和方法：我们评估了 561 名 TGCC 患者睾丸切除术前的黄体生成素 (LH)、总睾酮 (TT)、计算游离 T (cFT)、雌二醇和性激素结合球蛋白 (SHBG)，并与 561 名健康对照者进行比较。我们计算了 TT/LH 和 cFT/LH 比率，并根据对照构建了 TT/LH 和 cFT/LH 的双变量图表。以异常的 cFT/LH 比作为结果和临床分期、肿瘤大小、年龄、组织学、对侧生殖细胞原位肿瘤 (GCNIS) 的存在以及双侧肿瘤作为协变量进行逻辑回归分析。 结果：在人绒毛膜促性腺激素 (hCG) (n= 374)、TT (P= .004)、cFT (P< .001) 阴性的患者中， TT/LH 比率 (P= .003) 和 cFT/LH 比率 (P= .002) 低于对照组。当联合评估 TT/LH 和 cFT/LH 时，总共有 95 名 (25%) 和 91 名 (24%) hCG 阴性患者出现异常值。肿瘤大小的增加、对侧 GCNIS 和年龄的增加与 Leydig 细胞功能障碍有关。在 hCG 阳性的患者 (n = 187) 中，除 SHBG 外的所有生殖激素均与对照组不同 (P < .001)。结论：TGCC 患者在睾丸切除术前出现 Leydig 细胞功能障碍的风险增加。对侧 GCNIS、年龄的增加和肿瘤大小的增加与 Leydig 细胞功能障碍有关。我们假设先前存在间质细胞功能障碍的患者在治疗后出现睾酮缺乏的风险增加。
BACKGROUND: Little is known about preorchiectomy Leydig cell function in patients with testicular germ cell cancer (TGCC). The aim was to estimate the prevalence of preorchiectomy Leydig cell dysfunction and evaluate factors associated with this condition in a cohort of patients with TGCC.PATIENTS AND METHODS: We evaluated luteinizing hormone (LH), total testosterone (TT), calculated free T (cFT), estradiol, and sex hormone-binding globulin (SHBG) preorchiectomy in 561 patients with TGCC and compared with 561 healthy controls. We calculated TT/LH and cFT/LH ratios and constructed bivariate charts of TT/LH and cFT/LH from the controls. Logistic regression analysis with an abnormal cFT/LH ratio as outcome and clinical stage, tumor size, age, histology, presence of contralateral germ cell neoplasia in situ (GCNIS), and bilateral tumors as covariates was performed.RESULTS: In patients who were negative for human chorionic gonadotropin (hCG) (n= 374), TT (P= .004), cFT (P< .001), TT/LH ratio (P= .003), and cFT/LH ratio (P= .002) were lower than in controls. A total of 95 (25%) and 91 (24%) of hCG-negative patients had abnormal values when using combined evaluation of TT/LH and cFT/LH, respectively. Increasing tumor size, contralateral GCNIS, and increasing age were associated with Leydig cell dysfunction. In patients positive for hCG (n= 187), all reproductive hormones except SHBG were different from controls (P< .001).CONCLUSION: Patients with TGCC are at increased risk of Leydig cell dysfunction before orchiectomy. Contralateral GCNIS, increasing age, and increasing tumor size are associated with Leydig cell dysfunction. We hypothesize that patients with preexisting Leydig cell dysfunction are at increased risk of testosterone deficiency following treatment.