Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, McGill University, 3755 Côte Ste-Catherine Road, Suite A-114, Montreal, Quebec, H3T 1E2, Canada.
Pharmacoepidemiol Drug Saf. 2010 May;19(5):436-9. doi: 10.1002/pds.1943.
Prolonged warfarin use may decrease the risk of prostate cancer. We aimed to assess the effect of warfarin on histological grade and clinical stage of prostate cancer at diagnosis.
We carried out a retrospective population-based cohort study of men older than 50 years of age diagnosed with prostate cancer between 1985 and 2002 and registered with the Saskatchewan Cancer Registry. We compared a composite score of histological grade and clinical stage of prostate cancer at diagnosis according to warfarin use in the 5 years preceding the diagnosis of prostate cancer.
Compared with non-users, men with at least 2 years of cumulative warfarin use in the 5 year period preceding the diagnosis of prostate cancer were at a lower risk of a poor prognosis composite score at the time of their prostate cancer diagnosis (OR 0.40, 95%CI (0.19-0.83)), and when intermediate and poor prognosis scores were combined, a similar estimate of association was observed (OR 0.55, 95%CI (0.33-0.91)), adjusted for age at diagnosis and year of diagnosis. However, an increased risk of poor prognosis disease was observed with 4 years of cumulative warfarin use compared to never use (OR 2.2, 95%CI (1.03-4.81)).
There is a suggestion that at least 2 years of warfarin use is associated with a more favourable prognosis but that extended duration of use beyond 2 years may be associated with poor prognosis disease. Further investigation with a more complete assessment of confounders and that addresses potential detection biases is warranted.
长期使用华法林可能会降低前列腺癌的风险。我们旨在评估华法林对诊断时前列腺癌组织学分级和临床分期的影响。
我们对 1985 年至 2002 年间在萨斯喀彻温省癌症登记处登记并被诊断患有前列腺癌的年龄大于 50 岁的男性进行了回顾性基于人群的队列研究。我们根据在诊断前列腺癌前 5 年内使用华法林的情况，比较了诊断时前列腺癌组织学分级和临床分期的综合评分。
与未使用者相比，在诊断前列腺癌前 5 年内累积使用华法林至少 2 年的男性，在诊断时患有预后不良复合评分的风险较低（OR 0.40，95%CI（0.19-0.83）），当中间和不良预后评分合并时，也观察到类似的关联估计（OR 0.55，95%CI（0.33-0.91）），调整了诊断时的年龄和诊断年份。然而，与从未使用相比，累积使用华法林 4 年与预后不良疾病的风险增加相关（OR 2.2，95%CI（1.03-4.81））。
有迹象表明，至少 2 年的华法林使用与更有利的预后相关，但使用时间超过 2 年可能与预后不良的疾病相关。需要进一步调查，更完整地评估混杂因素，并解决潜在的检测偏倚。
