去势治疗后前列腺癌患者睾酮水平与肿瘤进展时间关系的回顾性研究

Retrospective Study on the Relationship between Testosterone Levels and Time to Tumor Progression in Prostate Cancer Patients Following Androgen Deprivation Therapy

摘要: 目的：探讨雄激素剥夺疗法(ADT^①)治疗后不同时间点睾酮水平对中国前列腺癌患者肿瘤进展时间的影响，为临床睾酮监测标准化管理提供依据。方法：回顾性收集重庆医科大学附属第二医院2011年1月至2026年1月仅接受ADT治疗的138例前列腺癌患者临床数据(224条记录)，按ADT治疗前AJCC分期分为III期及以下、IVA期、IVB期，各分期再按治疗后第一个月、第三个月睾酮水平(<20 ng/mL为低水平，≥20 ng/mL为高水平)分为4个亚组。采用Spearman等级相关分析、Kaplan-Meier生存分析及Cox比例风险回归模型，分析睾酮水平、睾酮下降率与肿瘤进展时间的关联。结果：随肿瘤分期进展，事件发生率升高、截尾率降低(III期及以下81.8%、IVA期60.6%、IVB期50.4%)。IVA、IVB期低睾酮亚组肿瘤进展时间显著长于高睾酮亚组(P < 0.001)，治疗后第三个月睾酮下降率相关系数高于第一个月(IVB期0.537 vs 0.366)，且为肿瘤进展的独立影响因素(IVA期HR = 5.618，IVB期HR = 0.283)；III期及以下各睾酮亚组肿瘤进展时间无显著差异(P > 0.05)，睾酮水平无独立预测价值。结论：ADT治疗后睾酮水平对前列腺癌肿瘤进展时间的影响存在分期特异性，IVA、IVB期需重点监测治疗后第三个月睾酮水平，结合基线PSA密度评估进展风险；III期及以下无需将睾酮作为主要监测指标，可为个体化干预提供参考。

Abstract: Objective: To investigate the impact of testosterone levels at different time points after Androgen Deprivation Therapy (ADT^①) on the time to tumor progression (TTP) in Chinese prostate cancer patients, providing evidence for the standardized management of testosterone monitoring in clinical practice. Methods: Clinical data from 138 prostate cancer patients (224 records) who received ADT alone at The Second Affiliated Hospital of Chongqing Medical University between January 2011 and January 2026 were retrospectively collected. Patients were stratified by AJCC stage before ADT into Stage III and below, Stage IVA, and Stage IVB. Each stage group was further divided into 4 subgroups based on testosterone levels at the first and third month post-treatment (low level: <20 ng/mL; high level: ≥20 ng/mL). Spearman rank correlation analysis, Kaplan-Meier survival analysis, and Cox proportional hazards regression models were used to analyze the association between testosterone levels, the rate of testosterone decline, and TTP. Results: As tumor stage progressed, the event rate increased and the censoring rate decreased (Stage III and below: 81.8%; Stage IVA: 60.6%; Stage IVB: 50.4%). In Stage IVA and IVB, the low-testosterone subgroups had a significantly longer TTP than the high-testosterone subgroups (P < 0.001). The correlation coefficient for the rate of testosterone decline at the third month was higher than that at the first month (Stage IVB: 0.537 vs. 0.366) and was an independent factor influencing tumor progression (Stage IVA: HR = 5.618; Stage IVB: HR = 0.283). In Stage III and below, there was no significant difference in TTP between testosterone subgroups (P > 0.05), and testosterone level had no independent predictive value. Conclusion: The influence of post-ADT testosterone levels on TTP in prostate cancer is stage-specific. For Stage IVA and IVB, close monitoring of testosterone levels at the third month post-treatment is crucial, and progression risk should be assessed in conjunction with baseline PSA density. For Stage III and below, testosterone need not be a primary monitoring indicator. These findings can provide references for individualized intervention.