Gandaglia Giorgio, Sun Maxine, Popa Ioana, Schiffmann Jonas, Trudeau Vincent, Shariat Shahrokh F, Trinh Quoc-Dien, Graefen Markus, Widmer Hugues, Saad Fred, Briganti Alberto, Montorsi Francesco, Karakiewicz Pierre I
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada; Department of Urology, Vita Salute San Raffaele University, Milan, Italy.
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada.
Clin Genitourin Cancer. 2015 Jun;13(3):e123-30. doi: 10.1016/j.clgc.2014.12.003. Epub 2014 Dec 9.
The aim of our study was to reexamine the prevalence of baseline cardiovascular (CV) morbidity and the rates of CV mortality in a contemporary cohort of patients with prostate cancer (PCa) exposed to androgen deprivation therapy (ADT).
Records of patients aged 65 years and older with metastatic PCa who received ADT were abstracted from the Surveillance, Epidemiology, and End Results-Medicare database between 1991 and 2009. The primary end points comprised 5-year CV mortality rates. Survival rates were stratified according to age and Charlson comorbidity index (CCI). Competing-risks Poisson regression methodologies were performed.
Overall, 9596 patients with metastatic PCa treated with ADT were identified. At baseline, 3049 patients (31.8%) had preexisting CV disease. The 5-year CV mortality rates were 9.8% and 14.8% in the overall population and in patients with preexisting CV disease, respectively. The 5-year CV mortality rates increased with advanced age and higher CCI score. In multivariate competing-risks regression analyses, age, year of diagnosis, CV comorbidities, CCI, and marital status represented independent predictors of CV mortality, after accounting for the risk of dying from other causes (all P ≤ .04). Of those, preexisting CV disease contributed to the highest risk of CV mortality. Our study is limited by its retrospective nature.
CV mortality represents a common event in patients with metastatic PCa treated with ADT. Preexisting CV disease represented the strongest risk factor.
我们研究的目的是重新审视当代接受雄激素剥夺疗法（ADT）的前列腺癌（PCa）患者队列中基线心血管（CV）疾病的患病率和CV死亡率。
从1991年至2009年的监测、流行病学和最终结果 - 医疗保险数据库中提取65岁及以上接受ADT的转移性PCa患者的记录。主要终点包括5年CV死亡率。生存率根据年龄和查尔森合并症指数（CCI）进行分层。采用竞争风险泊松回归方法。
总体而言，共识别出9596例接受ADT治疗的转移性PCa患者。基线时，3049例患者（31.8%）已有CV疾病。总体人群和已有CV疾病患者的5年CV死亡率分别为9.8%和14.8%。5年CV死亡率随年龄增长和CCI评分升高而增加。在多变量竞争风险回归分析中，在考虑死于其他原因的风险后，年龄、诊断年份、CV合并症、CCI和婚姻状况是CV死亡率的独立预测因素（所有P≤0.04）。其中，已有CV疾病导致CV死亡率风险最高。我们的研究受其回顾性性质的限制。
CV死亡率是接受ADT治疗的转移性PCa患者中的常见事件。已有CV疾病是最强的风险因素。
