King's College London, London, United Kingdom.
J Clin Oncol. 2010 Jul 20;28(21):3448-56. doi: 10.1200/JCO.2010.29.1567. Epub 2010 Jun 21.
Cardiovascular disease (CVD) is a potential adverse effect of endocrine treatment (ET) for prostate cancer (PC). We investigated absolute and relative CVD risk in 76,600 patients with PC undergoing ET, curative treatment, or surveillance.
PCBaSe Sweden is based on the National Prostate Cancer Register, which covers more than 96% of PC cases. Standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs) of ischemic heart disease (IHD), acute myocardial infarction (MI), arrhythmia, heart failure, and stroke were calculated to compare observed and expected (using total Swedish population) numbers of CVD, taking into account age, calendar time, and previous CVD.
Between 1997 and 2007, 30,642 patients with PC received primary ET, 26,432 curative treatment, and 19,527 surveillance. SIRs for CVD were elevated in all men with the highest for those undergoing ET, independent of circulatory disease history (SIR MI for men without circulatory disease history: 1.40 [95% CI, 1.31 to 1.49], 1.15 [95% CI, 1.01 to 1.31], and 1.20 [95% CI, 1.11 to 1.30] for men undergoing ET, curative treatment, and surveillance, respectively). Absolute risk differences (ARD) showed that two (arrhythmia) to eight (IHD) extra cases of CVD would occur per 1,000 person-years. SMRs showed similar patterns, with ARD of zero (arrhythmia) to three (IHD) per 1,000 person-years.
Increased relative risks of nonfatal and fatal CVD were found among all men with PC, especially those treated with ET. Because ET is currently the only effective treatment for metastatic disease and the ARDs were rather small, our findings indicate that CVD risk should be considered when prescribing ET but should not constitute a contraindication when the expected gain is tangible.
心血管疾病（CVD）是前列腺癌（PC）内分泌治疗（ET）的潜在不良反应。我们研究了 76600 例接受 ET、根治性治疗或监测的 PC 患者的绝对和相对 CVD 风险。
PCBaSe 瑞典基于国家前列腺癌登记处，该登记处涵盖了超过 96%的 PC 病例。计算了缺血性心脏病（IHD）、急性心肌梗死（MI）、心律失常、心力衰竭和中风的标准化发病率比（SIR）和标准化死亡率比（SMR），以比较观察到的和预期的（使用全瑞典人口）CVD 数量，同时考虑年龄、日历时间和先前的 CVD。
1997 年至 2007 年期间，30642 例 PC 患者接受了初始 ET，26432 例接受了根治性治疗，19527 例接受了监测。所有男性的 CVD SIR 均升高，其中接受 ET 的男性最高，与心血管疾病史无关（无心血管疾病史的男性 MI 的 SIR：1.40[95%CI，1.31 至 1.49]、1.15[95%CI，1.01 至 1.31]和 1.20[95%CI，1.11 至 1.30]，分别为接受 ET、根治性治疗和监测的男性）。绝对风险差异（ARD）表明，每 1000 人年将发生 2 例（心律失常）至 8 例（IHD）额外的 CVD 病例。SMR 显示出相似的模式，ARD 为每 1000 人年零（心律失常）至 3 例（IHD）。
所有 PC 男性，尤其是接受 ET 治疗的男性，均发现非致命性和致命性 CVD 的相对风险增加。由于 ET 目前是治疗转移性疾病的唯一有效方法，而且 ARD 相当小，因此我们的研究结果表明，在开具 ET 处方时应考虑 CVD 风险，但在预期收益明显时不应将其作为禁忌症。
