Zhao Jinsheng, Zhu Shimiao, Sun Libin, Meng Fanzheng, Zhao Lin, Zhao Yusheng, Tian Hao, Li Ping, Niu Yuanjie
Tianjin Medical University, Tianjin, China; Department of Neurology, Tianjin Nankai Hospital, Tianjin, China; Department of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical Unversity, Tianjin, China.
Tianjin Medical University, Tianjin, China; Department of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical Unversity, Tianjin, China.
PLoS One. 2014 Sep 29;9(9):e107516. doi: 10.1371/journal.pone.0107516. eCollection 2014.
There is no consensus regarding whether androgen deprivation therapy (ADT) is associated with cardiovascular disease (CVD) and cardiovascular mortality (CVM). The objective of this study was to determine the role of ADT for prostate cancer (PCa) in development of cardiovascular events (CVD and CVM).
We performed a meta-analysis from population-based observational studies comparing ADT vs control aimed at treating PCa in patients with PCa, reporting either CVD or CVM as outcome. Publications were searched using Medline, Embase, Cochrane Library Central Register of observational studies database up to May 31th 2014, and supplementary searches in publications from potentially relevant journals. 6 studies were identified with a total of 129,802 ADT users and 165,605 controls investigating the relationship between ADT and CVD. The incidence of CVD was 10% higher in ADT groups, although no significant association was observed (HR = 1.10, 95%CIs: 1.00-1.21; P = 0.06). For different types of ADT, CVD was related with gonadotropin-releasing hormone (GnRH) (HR = 1.19, 95%CIs: 1.04-1.36; P<0.001) and GnRH plus oral antiandrogen (AA) (HR = 1.46, 95%CIs: 1.03-2.08; P = 0.04), but not with AA alone or orchiectomy. For CVM, 119,625 ADT users and 150,974 controls from 6 eligible studies were included, pooled results suggested that ADT was associated with CVM (HR = 1.17, 95%CIs: 1.04-1.32; P = 0.01). Significantly increased CVM was also detected in GnRH and GnRH plus AA groups. When patients received other treatments (e.g. prostatectomy and radiotherapy) were ruled out of consideration, more increased CVD (HR = 1.19, 95%CIs: 1.08-1.30; P<0.001) and CVM (HR = 1.30, 95%CIs: 1.13-1.50; P<0.001) were found in men treated with ADT monotherapy.
ADT is associated with both CVD and CVM. Particularly, GnRH alone and GnRH plus AA can significantly increase the incidence of cardiovascular events in patients with PCa.
对于雄激素剥夺疗法（ADT）是否与心血管疾病（CVD）及心血管死亡率（CVM）相关，目前尚无定论。本研究的目的是确定ADT治疗前列腺癌（PCa）在心血管事件（CVD和CVM）发生发展中的作用。
我们对基于人群的观察性研究进行了荟萃分析，比较ADT与对照组治疗PCa患者的情况，以CVD或CVM作为结局指标进行报告。使用Medline、Embase、Cochrane图书馆观察性研究数据库中心注册库检索截至2014年5月31日的出版物，并对潜在相关期刊的出版物进行补充检索。共纳入6项研究，总计129,802名ADT使用者和165,605名对照，研究ADT与CVD之间的关系。ADT组的CVD发病率高10%，尽管未观察到显著关联（HR = 1.10，95%置信区间：1.00 - 1.21；P = 0.06）。对于不同类型的ADT，CVD与促性腺激素释放激素（GnRH）（HR = 1.19，95%置信区间：1.04 - 1.36；P < 0.001）以及GnRH加口服抗雄激素药物（AA）（HR = 1.46，95%置信区间：1.03 - 2.08；P = 0.04）相关，但与单独使用AA或睾丸切除术无关。对于CVM，纳入了6项符合条件研究中的119,625名ADT使用者和150,974名对照，汇总结果表明ADT与CVM相关（HR = 1.17，95%置信区间：1.04 - 1.32；P = 0.01）。在GnRH组和GnRH加AA组中也检测到CVM显著增加。当排除接受其他治疗（如前列腺切除术和放疗）的患者后，接受ADT单药治疗的男性中CVD（HR = 1.19，95%置信区间：1.08 - 1.30；P < 0.001）和CVM（HR = 1.30，95%置信区间：1.13 - 1.50；P < 0.001）的增加更为明显。
ADT与CVD和CVM均相关。特别是，单独使用GnRH以及GnRH加AA可显著增加PCa患者心血管事件的发生率。
