Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, 3755 Côte-Ste-Catherine, Suite H-410.1, Montreal, QC, H3T 1E2, Canada.
Cancer Causes Control. 2013 Jun;24(6):1079-85. doi: 10.1007/s10552-013-0185-1. Epub 2013 Mar 15.
Recent evidence suggests that warfarin use may be associated with a reduced risk of prostate cancer. We aimed to determine whether exposure to warfarin is also associated with a reduced risk of prostate cancer death.
A nested case-control study was conducted within a population-based cohort of 10,012 men aged ≥50 years with newly diagnosed prostate cancer between 1985 and 2002 and with no history of cancer since 1970 using the linked records of Saskatchewan Health and Saskatchewan Cancer Agency registry. We identified 2,309 cases who died of prostate cancer during follow-up. For each case, one control alive at the time of the case's death and matched for length of follow-up (±6 months) was randomly selected. Prescription counts were used to define warfarin exposure. Multivariate conditional logistic regression analysis was used to calculate the adjusted incidence rates of prostate cancer death in relation to warfarin use while adjusting for confounding by age, year of prostate cancer diagnosis, clinical stage and grade of cancer at diagnosis, Chronic Disease Score, and use of warfarin before diagnosis.
Ever use of warfarin following a diagnosis of prostate cancer was associated with an adjusted rate ratio of 1.44 (95 % confidence interval (CI) 1.33-1.84) for prostate cancer death. The adjusted rate ratio with one-year use of warfarin was 1.77 (95 % CI 1.25-2.50) compared to never use. The unadjusted rate ratio with five-year use of warfarin was 0.64 (95 % CI 0.40-1.00) and remained unchanged in the adjusted analysis (0.65, 95 % CI 0.37-1.13), although no longer statistically significant.
Our study does not provide conclusive evidence for a protective effect of long-term warfarin on prostate cancer-specific mortality. Moreover, short-term warfarin use may be associated with an increased risk of prostate cancer death.
最近的证据表明，华法林的使用可能与降低前列腺癌风险有关。我们旨在确定华法林的暴露是否也与降低前列腺癌死亡风险有关。
在一个基于人群的队列中进行了一项嵌套病例对照研究，该队列包括 1985 年至 2002 年间诊断为前列腺癌且自 1970 年以来无癌症病史的 10012 名年龄≥50 岁的男性。我们确定了 2309 例在随访期间死于前列腺癌的病例。对于每个病例，在病例死亡时选择一名与随访时间（±6 个月）相匹配的存活对照。使用处方计数来定义华法林暴露。使用多变量条件逻辑回归分析来计算与华法林使用相关的前列腺癌死亡的调整发病率，同时调整年龄、前列腺癌诊断年份、诊断时癌症的临床分期和分级、慢性疾病评分以及诊断前华法林的使用等混杂因素的影响。
在诊断为前列腺癌后使用华法林与前列腺癌死亡的调整后率比为 1.44（95%置信区间[CI] 1.33-1.84）。与从不使用相比，使用华法林一年的调整后率比为 1.77（95%CI 1.25-2.50）。使用华法林五年的未调整率比为 0.64（95%CI 0.40-1.00），在调整分析中保持不变（0.65，95%CI 0.37-1.13），尽管不再具有统计学意义。
我们的研究没有提供长期使用华法林对前列腺癌特异性死亡率具有保护作用的确凿证据。此外，短期使用华法林可能与前列腺癌死亡风险增加有关。
