Department of Medicine, Section of Neoplastic Diseases and Related Disorders, Medical College of Wisconsin, Milwaukee, WI, USA.
Urology. 2011 Apr;77(4):934-40. doi: 10.1016/j.urology.2010.11.024. Epub 2011 Jan 26.
To test the hypothesis that early androgen deprivation therapy (ADT) has no proven survival advantage in older men with biochemical recurrence (BCR) of prostate cancer (PCa), and it may contribute to geriatric frailty.
We conducted a case-control study of men aged 60+ years with BCR on ADT (n = 63) vs PCa survivors without recurrence (n = 71). Frailty prevalence, "obese" frailty, Short Physical Performance Battery (SPPB) scores, and falls were compared. An exploratory analysis of frailty biomarkers (C-reactive protein, erythrocyte sedimentation rate, hemoglobin, albumin, and total cholesterol) was performed. Summary statistics and univariate and multivariate regression analyses were conducted.
More patients on ADT were obese (body mass index >30; 46.2% vs 20.6%; P = .03). There were no statistical differences in SPPB (P = .41) or frailty (P = .20). Using a proposed "obese" frailty criteria, 8.7% in ADT group were frail and 56.5% were "prefrail," compared with 2.9% and 48.8% of controls (P = .02). Falls in the last year were higher in the ADT group (14.3% vs 2.8%; P = .02). In analyses controlling for age, clinical characteristics, and comorbidities, the ADT group trended toward significance for "obese" frailty (P = .14) and falls (OR = 4.74, P = .11). Comorbidity significantly increased the likelihood of "obese" frailty (P = .01) and falls (OR 2.02, P = .01).
Men with BCR on ADT are frailer using proposed modified "obese" frailty criteria. They may have lower performance status and more falls. A larger, prospective trial is necessary to establish a causal link between ADT use and progression of frailty and disability.
检验以下假设，即早期雄激素剥夺疗法（ADT）对于生化复发（BCR）的老年前列腺癌（PCa）患者并无生存优势，反而可能导致老年虚弱。
我们进行了一项病例对照研究，纳入了 60 岁以上接受 ADT 治疗的 BCR 患者（n = 63）和未复发的 PCa 幸存者（n = 71）。比较了虚弱发生率、“肥胖”型虚弱、简易体能状况量表（SPPB）评分和跌倒情况。对虚弱生物标志物（C 反应蛋白、红细胞沉降率、血红蛋白、白蛋白和总胆固醇）进行了探索性分析。采用汇总统计、单变量和多变量回归分析进行评估。
更多接受 ADT 的患者为肥胖（体重指数＞30；46.2% vs 20.6%；P =.03）。两组间 SPPB 评分（P =.41）或虚弱程度（P =.20）均无统计学差异。根据“肥胖”型虚弱的标准，ADT 组中 8.7%为虚弱，56.5%为“虚弱前期”，而对照组中分别为 2.9%和 48.8%（P =.02）。ADT 组患者在过去一年中跌倒的比例更高（14.3% vs 2.8%；P =.02）。在调整年龄、临床特征和合并症后，ADT 组的“肥胖”型虚弱（P =.14）和跌倒（比值比[OR] = 4.74，P =.11）更接近统计学意义。合并症显著增加了“肥胖”型虚弱（P =.01）和跌倒（OR 2.02，P =.01）的可能性。
根据改良的“肥胖”型虚弱标准，接受 BCR 治疗的 ADT 患者更为虚弱。他们的表现状态可能更差，跌倒的风险更高。需要进行更大规模的前瞻性试验，以确定 ADT 应用与虚弱和残疾进展之间的因果关系。
