术前性激素水平作为睾丸恶性肿瘤形态特征的预测因素(预后因素

Q4 Medicine
R. F. Kholbobozoda, A. Kostin, N. Vorobyev, A. Tolkachev, A. A. Krasheninnikov, I. A. Taraki, A. Kaprin
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Localized, locally advanced and metastatic testicular cancer was diagnosed in 55 (83.3 %), 9 (13.6 %) and 2 (3.0 %) patients, respectively. A preoperative assessment of hormones such as total and free testosterone (T), estradiol (E2)), gonadotropic hormones (LH, FLH, Prolactin) and b-HCG was carried out. Patients were divided into 2 groups depending on the histological structure of the tumor: seminoma (n=31) and non-seminoma (n=35). The following parameters were assessed: tumor size, lymphovascular invasion and rete testis invasion. Results. In non-seminoma tumors, the values of sex hormones and beta-hCG were higher, but the values of gonadotropic hormones were lower compared with typical seminomas (p<0.05). High concentrations of b-HCG were observed predominantly in pT3 compared to pT1 stages (p=0.018). 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引用次数: 0

摘要

导言睾丸癌(TC)多发于育龄期的年轻男性。多项研究表明,睾丸癌患者体内的性激素水平与血清肿瘤标志物之间存在相关性。然而,目前对睾丸切除术前的激素水平与肿瘤的临床和病理形态学特征之间的关系尚未进行充分研究。研究目的:分析睾丸癌患者激素水平与肿瘤临床分期和组织学特征之间的关系,并建立预后模型。材料与方法。这项前瞻性单中心研究纳入了 66 名睾丸癌患者。55例(83.3%)、9例(13.6%)和2例(3.0%)患者被诊断为局部、局部晚期和转移性睾丸癌。术前对总睾酮(T)、游离睾酮(T)、雌二醇(E2)、促性腺激素(LH、FLH、催乳素)和 b-HCG 等激素进行了评估。根据肿瘤的组织学结构,患者被分为两组:精原细胞瘤(31 人)和非精原细胞瘤(35 人)。对以下参数进行了评估:肿瘤大小、淋巴管侵犯和睾丸骨膜侵犯。结果与典型精原细胞瘤相比,非精原细胞瘤的性激素和β-hCG值较高,但促性腺激素值较低(P<0.05)。与 pT1 阶段相比,主要在 pT3 阶段观察到高浓度的 b-HCG(p=0.018)。相关分析表明,总T(ρ=0.351;p=0.004)和游离T(ρ=0.342;p=0.008)、E2(ρ=0.292;p=0.022)、b-HCG(ρ=0.244;p=0.048)、LH(ρ=-0.287;p=0.039)、FSH(ρ=-0.264;p=0.04)与原发肿瘤的大小有关。与无此预后参数的患者相比,有睾丸隐窝侵犯的患者LH值低,b-HCG值高(分别为p=0.015和p<0.001)。建立的预后模型可确定组织学结构和存在睾丸前叶侵犯的概率(p<0.001),灵敏度(82.1%和76.5%)和特异性(76.9%和100%)都很高。结论研究结果表明,非精原细胞瘤与垂体-性腺轴(HPG)的变化有关。睾丸切除术前性激素的高值和促性腺激素的低值与原发肿瘤的大尺寸有关。此外,低 LH 值和高 b-HCG 值也是睾丸前叶受侵的预测因素。高b-HCG水平与肿瘤生物学侵袭性更强和预后不良有关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Preoperative level of sex hormones as a predictor (prognostic factor) of the morphological characteristics of testicular malignancies
Introduction. Testicular cancer (TC) mostly affect young men of reproductive age. Several studies have shown correlation between the level of sex hormones in testicular cancer and serum tumor markers. However, currently, the relationship between hormone levels before orchidectomy and the clinical and pathomorphological characteristics of the tumor has not been sufficiently studied. Aim of the study: to analyze the relationship between hormone levels and the clinical stage and histological characteristics of the tumor in patients with testicular cancer and to develop prognostic models. Material and Methods. This prospective single-center study included 66 patients with testicular cancer. Localized, locally advanced and metastatic testicular cancer was diagnosed in 55 (83.3 %), 9 (13.6 %) and 2 (3.0 %) patients, respectively. A preoperative assessment of hormones such as total and free testosterone (T), estradiol (E2)), gonadotropic hormones (LH, FLH, Prolactin) and b-HCG was carried out. Patients were divided into 2 groups depending on the histological structure of the tumor: seminoma (n=31) and non-seminoma (n=35). The following parameters were assessed: tumor size, lymphovascular invasion and rete testis invasion. Results. In non-seminoma tumors, the values of sex hormones and beta-hCG were higher, but the values of gonadotropic hormones were lower compared with typical seminomas (p<0.05). High concentrations of b-HCG were observed predominantly in pT3 compared to pT1 stages (p=0.018). Correlation analysis revealed a connection between total (ρ=0.351; p=0.004) and free T (ρ=0.342; p=0.008), E2 (ρ=0.292; p=0.022), b-HCG (ρ=0.244; p= 0.048), LH (ρ=-0.287; p=0.039), FSH (ρ=-0.264; p=0.04) and the size of the primary tumor. The presence of rete testis invasion was accompanied by a low LH value and a high b-HCG value compared to patients without this prognostic parameter (p=0.015, p<0.001, respectively). Prognostic models were developed to determine the probability of histological structure and the presence of rete testis invasion (p<0.001) with high sensitivity (82.1 % and 76.5 %) and specificity (76.9 % and 100 %). Conclusion. The findings suggest that non-seminoma tumors are associated with changes in the pituitary-gonadal (HPG) axis. The high values of sex hormones and low values of gonadotropic hormones before orchidectomy are associated with a large size of the primary tumor. Additionally, a low LH value and a high b-HCG value are predictors of rete testis invasion. High b-HCG levels are associated with more aggressive tumor biology and poor prognosis.
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来源期刊
Siberian journal of oncology
Siberian journal of oncology Medicine-Oncology
CiteScore
0.40
自引率
0.00%
发文量
117
审稿时长
8 weeks
期刊介绍: The main objectives of the journal are: -to promote the establishment of Russia’s leading worldwide positions in the field of experimental and clinical oncology- to create the international discussion platform intended to cover all aspects of basic and clinical cancer research, including carcinogenesis, molecular biology, epidemiology, cancer prevention, diagnosis and multimodality treatment (surgery, chemotherapy, radiation therapy, hormone therapy), anesthetic management, medical and social rehabilitation, palliative care as well as the improvement of life quality of cancer patients- to encourage promising young scientists to be actively involved in cancer research programs- to provide a platform for researches and doctors all over the world to promote, share, and discuss various new issues and developments in cancer related problems. (to create a communication platform for the expansion of cooperation between Russian and foreign professional associations).- to provide the information about the latest worldwide achievements in different fields of oncology The most important tasks of the journal are: -to encourage scientists to publish their research results- to offer a forum for active discussion on topics of major interest - to invite the most prominent Russian and foreign authors to share their latest research findings with cancer research community- to promote the exchange of research information, clinical experience, current trends and the recent developments in the field of oncology as well as to review interesting cases encountered by colleagues all over the world- to expand the editorial board and reviewers with the involvement of well-known Russian and foreign experts- to provide open access to full text articles- to include the journal into the international database- to increase the journal’s impact factor- to promote the journal to the International and Russian markets
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