Teoh Jeremy Y C, Chan Samson Y S, Chiu Peter K F, Poon Darren M C, Cheung Ho-Yuen, Hou Simon S M, Ng Chi-Fai
Division of Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, China.
Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, China.
BJU Int. 2015 Sep;116(3):382-7. doi: 10.1111/bju.12967. Epub 2015 Mar 7.
To investigate the risk of acute myocardial infarction (AMI) after androgen-deprivation therapy (ADT) for prostate cancer in a Chinese population.
All Chinese patients with prostate cancer who were treated primarily with radical prostatectomy or radiotherapy, with or without further ADT at our hospital from the year 2000 to 2009 were retrospectively reviewed. We compared the risk of AMI in the patients who were given further ADT (ADT group) with those who were not given any ADT (non-ADT group). Potential risk factors of AMI including age, diabetes mellitus, hypertension, hyperlipidaemia, history of stroke, ischaemic heart disease, Eastern Cooperative Oncology Group Performance Status (ECOG PS) and duration of ADT were reviewed. The risk of AMI after ADT was first analysed using the Kaplan-Meier method, followed by Cox regression analyses including the potential risk factors mentioned.
In all, 452 patients were included, with 200 patients in the non-ADT group and 252 patients in the ADT group. The mean (sd) age was 68.2 (5.9) years in the non-ADT group and 69.5 (6.5) years in the ADT group, and the difference was statistically significant (P = 0.031). There were no significant differences in their pre-existing medical conditions or ECOG PS. The ADT group was associated with an increased risk of AMI when compared with the non-ADT group (P = 0.004) upon Kaplan-Meier analysis. Upon multivariate Cox regression analysis, hyperlipidaemia, poor ECOG PS and the use of ADT were the only three significant factors that were associated with increased risk of developing new AMI.
There was increased risk of AMI after ADT for prostate cancer in a Chinese population. Hyperlipidaemia and poor ECOG PS were also significant risk factors for developing AMI. The risk of AMI should be considered when deciding on ADT, especially in patients with history of hyperlipidaemia and relatively poor ECOG PS.
探讨在中国人群中，前列腺癌雄激素剥夺治疗（ADT）后发生急性心肌梗死（AMI）的风险。
回顾性分析了2000年至2009年期间在我院接受前列腺癌根治术或放疗为主治疗的所有中国患者，这些患者接受或未接受进一步的ADT治疗。我们比较了接受进一步ADT治疗的患者（ADT组）和未接受任何ADT治疗的患者（非ADT组）发生AMI的风险。回顾了AMI的潜在风险因素，包括年龄、糖尿病、高血压、高脂血症、中风史、缺血性心脏病、东部肿瘤协作组体能状态（ECOG PS）和ADT持续时间。首先采用Kaplan-Meier方法分析ADT后发生AMI的风险，随后进行Cox回归分析，纳入上述潜在风险因素。
共纳入452例患者，非ADT组200例，ADT组252例。非ADT组的平均（标准差）年龄为68.2（5.9）岁，ADT组为69.5（6.5）岁，差异有统计学意义（P = 0.031）。他们既往的基础疾病或ECOG PS无显著差异。Kaplan-Meier分析显示，与非ADT组相比，ADT组发生AMI的风险增加（P = 0.004）。多因素Cox回归分析显示，高脂血症、ECOG PS差和使用ADT是与新发AMI风险增加相关的仅有的三个显著因素。
在中国人群中，前列腺癌ADT后发生AMI的风险增加。高脂血症和ECOG PS差也是发生AMI的重要风险因素。在决定是否进行ADT时，应考虑发生AMI的风险，尤其是对于有高脂血症病史且ECOG PS相对较差的患者。
