Gandaglia Giorgio, Sun Maxine, Popa Ioana, Schiffmann Jonas, Abdollah Firas, Trinh Quoc-Dien, Saad Fred, Graefen Markus, Briganti Alberto, Montorsi Francesco, Karakiewicz Pierre I
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada.
Urological Research Institute, Vita-Salute San Raffaele University, San Raffaele Hospital, San Raffaele Scientific Institute, Milan, Italy.
BJU Int. 2014 Dec;114(6b):E82-E89. doi: 10.1111/bju.12732. Epub 2014 Jul 27.
To examine and quantify the contemporary association between androgen-deprivation therapy (ADT) and three separate endpoints: coronary artery disease (CAD), acute myocardial infarction (AMI), and sudden cardiac death (SCD), in a large USA contemporary cohort of patients with prostate cancer.
In all, 140 474 patients diagnosed with non-metastatic prostate cancer between 1995 and 2009 within the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database were abstracted. Patients treated with ADT and those not receiving ADT were matched using propensity score methodology. The 10-year CAD, AMI, and SCD rates were estimated. Competing-risks regression analyses tested the association between the type of ADT (GnRH agonists vs bilateral orchidectomy) and CAD, AMI, and SCD, after adjusting for the risk of dying during follow-up.
Overall, the 10-year rates of CAD, AMI, and SCD were 25.9%, 15.6%, and 15.8%, respectively. After stratification according to ADT status (ADT-naïve vs GnRH agonists vs bilateral orchidectomy), the CAD rates were 25.1% vs 26.9% vs 23.2%, the AMI rates were 14.8% vs 16.6% vs 14.8%, and the SCD rates were 14.2% vs 17.7% vs 16.4%, respectively. In competing-risks multivariable regression analyses, the administration of GnRH agonists (all P < 0.001), but not bilateral orchidectomy (all P ≥ 0.7), was associated with higher risk of CAD, AMI, and SCD.
The administration of GnRH agonists, but not orchidectomy, is still associated with a significantly increased risk of CAD, AMI, and, especially, SCD in patients with non-metastatic prostate cancer. Alternative forms of ADT should be considered in patients at higher risk of CV events.
在美国一个大型当代前列腺癌患者队列中，研究并量化雄激素剥夺治疗（ADT）与三个独立终点之间的当代关联：冠状动脉疾病（CAD）、急性心肌梗死（AMI）和心源性猝死（SCD）。
从监测、流行病学和最终结果（SEER）-医疗保险链接数据库中提取了1995年至2009年间诊断为非转移性前列腺癌的140474例患者。使用倾向评分方法对接受ADT治疗的患者和未接受ADT治疗的患者进行匹配。估计了10年CAD、AMI和SCD发生率。竞争风险回归分析在调整随访期间死亡风险后，检验了ADT类型（GnRH激动剂与双侧睾丸切除术）与CAD、AMI和SCD之间的关联。
总体而言，CAD、AMI和SCD的10年发生率分别为25.9%、15.6%和15.8%。根据ADT状态分层后（未接受ADT治疗与GnRH激动剂与双侧睾丸切除术），CAD发生率分别为25.1%、26.9%和23.2%，AMI发生率分别为14.8%、16.6%和14.8%，SCD发生率分别为14.2%、17.7%和16.4%。在竞争风险多变量回归分析中，GnRH激动剂的使用（所有P<0.001），而非双侧睾丸切除术（所有P≥0.7），与CAD、AMI和SCD的较高风险相关。
GnRH激动剂的使用，而非睾丸切除术，仍与非转移性前列腺癌患者CAD、AMI尤其是SCD的显著风险增加相关。对于心血管事件风险较高的患者，应考虑采用其他形式的ADT。
