Division of Population Studies and Prevention, Karmanos Cancer Institute, Detroit, MI, USA.
Ann Epidemiol. 2011 Mar;21(3):156-63. doi: 10.1016/j.annepidem.2010.10.003. Epub 2010 Dec 15.
The side-effects associated with androgen deprivation therapy (ADT) include weight gain, dyslipidemia, and insulin resistance. As cataracts have been linked to these metabolic abnormalities, an increased risk of cataract may be another adverse consequence of ADT use.
Using data from the Surveillance, Epidemiology and End Results-Medicare database, we estimated risk of cataract associated with ADT among 65,852 prostate-cancer patients. ADT treatment was defined as at least one dose of a gonadotropin-releasing hormone agonist or orchiectomy within 6 months after prostate cancer diagnosis. The outcome measure was a first claim of cataract diagnosis identified in Medicare claim files. Cox regression was used to estimate hazard ratios (HR) for the effects of ADT treatment, controlling for confounders.
Gonadotropin-releasing hormone agonist use was associated with a modest increase in cataract incidence (HR 1.09, 95% confidence interval 1.06-1.12). Orchiectomy was also associated with an increased risk of cataract among men with no history of cataract prior to prostate cancer diagnosis (HR 1.26, 95% confidence interval 1.07-1.47).
In the first systematic investigation of the association between ADT and cataract, our results suggest an elevation in the incidence of cataract among ADT users. Further study, preferably prospective in design, is needed to provide additional evidence to support or refute these findings.
与雄激素剥夺疗法（ADT）相关的副作用包括体重增加、血脂异常和胰岛素抵抗。由于白内障与这些代谢异常有关，因此 ADT 的使用可能会导致白内障风险增加。
我们使用 Surveillance, Epidemiology and End Results-Medicare 数据库中的数据，估计了 65852 例前列腺癌患者中与 ADT 相关的白内障风险。ADT 治疗定义为在前列腺癌诊断后 6 个月内至少使用一次促性腺激素释放激素激动剂或睾丸切除术。结局指标是在 Medicare 索赔文件中首次确诊白内障的索赔。Cox 回归用于估计 ADT 治疗效果的风险比（HR），同时控制混杂因素。
促性腺激素释放激素激动剂的使用与白内障发病率的适度增加相关（HR 1.09，95%置信区间 1.06-1.12）。对于前列腺癌诊断前没有白内障病史的男性，睾丸切除术也与白内障风险增加相关（HR 1.26，95%置信区间 1.07-1.47）。
在对 ADT 与白内障之间的关联进行的首次系统研究中，我们的结果表明 ADT 使用者的白内障发病率升高。需要进一步的研究，最好是前瞻性设计，以提供更多的证据来支持或反驳这些发现。
