Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
J Natl Cancer Inst. 2010 Mar 3;102(5):307-14. doi: 10.1093/jnci/djp537. Epub 2010 Feb 2.
BACKGROUND: Receiving a cancer diagnosis is a stressful event that may increase risks of suicide and cardiovascular death, especially soon after diagnosis. METHODS: We conducted a cohort study of 342,497 patients diagnosed with prostate cancer from January 1, 1979, through December 31, 2004, in the Surveillance, Epidemiology, and End Results Program. Follow-up started from the date of prostate cancer diagnosis to the end of first 12 calendar months after diagnosis. The relative risks of suicide and cardiovascular death were calculated as standardized mortality ratios (SMRs) comparing corresponding incidences among prostate cancer patients with those of the general US male population, with adjustment for age, calendar period, and state of residence. We compared risks in the first year and months after a prostate cancer diagnosis. The analyses were further stratified by calendar period at diagnosis, tumor characteristics, and other variables. RESULTS: During follow-up, 148 men died of suicide (mortality rate = 0.5 per 1000 person-years) and 6845 died of cardiovascular diseases (mortality rate = 21.8 per 1000 person-years). Patients with prostate cancer were at increased risk of suicide during the first year (SMR = 1.4, 95% confidence interval [CI] = 1.2 to 1.6), especially during the first 3 months (SMR = 1.9, 95% CI = 1.4 to 2.6), after diagnosis. The elevated risk was apparent in pre-prostate-specific antigen (PSA) (1979-1986) and peri-PSA (1987-1992) eras but not since PSA testing has been widespread (1993-2004). The risk of cardiovascular death was slightly elevated during the first year (SMR = 1.09, 95% CI = 1.06 to 1.12), with the highest risk in the first month (SMR = 2.05, 95% CI = 1.89 to 2.22), after diagnosis. The first-month risk was statistically significantly elevated during the entire study period, and the risk was higher for patients with metastatic tumors (SMR = 3.22, 95% CI = 2.68 to 3.84) than for those with local or regional tumors (SMR = 1.57, 95% CI = 1.42 to 1.74). CONCLUSION: A diagnosis of prostate cancer may increase the immediate risks of suicide and cardiovascular death.
背景：诊断出患有癌症是一件压力很大的事情，尤其是在诊断后不久，可能会增加自杀和心血管死亡的风险。
方法：我们对 1979 年 1 月 1 日至 2004 年 12 月 31 日期间在美国监测、流行病学和最终结果计划中被诊断患有前列腺癌的 342497 名患者进行了队列研究。随访从前列腺癌诊断之日开始，到诊断后 12 个日历月结束。通过将前列腺癌患者的相应发病率与普通美国男性人口的发病率进行比较，计算自杀和心血管死亡的相对风险作为标准化死亡率比（SMR），并调整年龄、日历期和居住州。我们比较了前列腺癌诊断后第一年和几个月后的风险。分析还按诊断时的日历期、肿瘤特征和其他变量进行分层。
结果：在随访期间，有 148 名男性死于自杀（死亡率为 0.5/1000 人年），有 6845 名男性死于心血管疾病（死亡率为 21.8/1000 人年）。前列腺癌患者在诊断后第一年（SMR=1.4，95%置信区间[CI]：1.2 至 1.6），尤其是在诊断后前 3 个月（SMR=1.9，95%CI：1.4 至 2.6），自杀风险增加。在前列腺特异性抗原（PSA）前（1979-1986 年）和 PSA 期间（1987-1992 年）风险明显升高，但自 PSA 检测广泛应用以来（1993-2004 年）则不然。在第一年期间，心血管死亡风险略有升高（SMR=1.09，95%CI：1.06 至 1.12），诊断后第一个月风险最高（SMR=2.05，95%CI：1.89 至 2.22）。在整个研究期间，第一个月的风险显著升高，并且转移性肿瘤患者的风险更高（SMR=3.22，95%CI：2.68 至 3.84），而局部或区域性肿瘤患者的风险较低（SMR=1.57，95%CI：1.42 至 1.74）。
结论：前列腺癌的诊断可能会立即增加自杀和心血管死亡的风险。
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