Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan.
Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
BMJ Open. 2017 Feb 28;7(2):e012950. doi: 10.1136/bmjopen-2016-012950.
This study investigated the risk of ischaemic bowel syndrome (IBS) in androgen deprivation therapy (ADT) users to explore the long-term outcomes of patients with prostate cancer (PC) receiving ADT treatment.
We performed a population-based retrospective cohort study. All the clinical information of the study participants were acquired from the Longitudinal Health Insurance Database for Catastrophic Illness Patients in Taiwan. We extracted data for all the patients newly diagnosed with prostate malignancy (ICD-9-CM 185 or C61 in ICD-10-CM) from 2000 to 2008. The patients were then divided into two groups: 7160 male ADT cohort receiving ADT and 7160 male non-ADT comparison group frequency matched by age and index year of ADT treatment of the ADT group. Cox proportional hazard regression was used to estimate the adjusted HR and 95% CIs of the IBS risk.
No significant difference was noted in the overall incidence rate for IBS between the ADT and non-ADT cohorts (0.86 and 0.89 per 1000 person-year, respectively, p=0.89). Even after adjusting for potential risk factors, a 1.06-fold risk of IBS (95% CI 0.62 to 1.82, p=0.82) was observed in the ADT cohort relative to the non-ADT cohorts. Moreover, we stratified the ADT cohort by time point of ADT treatment after PC diagnosis. Different IBS incidence rates were observed among the early ADT, late-ADT and non-ADT users at 0.77, 1.23 and 0.89 per 1000 person-years, respectively; nonetheless, the difference was not statistically significant. Moreover, no difference was found between the ADT treatment types and IBS risk, including sole orchiectomy, sole luteinising-hormone-releasing hormone and both.
Results showed that ADT treatment in patients with PC is not an independent factor for IBS incidence. Large sample sizes for patients with IBS with patients with PC who had received ADT treatment are needed for further study.
本研究旨在探讨雄激素剥夺疗法（ADT）使用者发生缺血性肠综合征（IBS）的风险，以探究接受 ADT 治疗的前列腺癌（PC）患者的长期结局。
我们进行了一项基于人群的回顾性队列研究。所有研究参与者的临床信息均来自台湾灾难性疾病医疗保险纵向数据库。我们从 2000 年至 2008 年提取了所有新诊断为前列腺恶性肿瘤（ICD-9-CM 185 或 ICD-10-CM 中的 C61）的患者的数据。然后，我们将患者分为两组：7160 名接受 ADT 的男性 ADT 队列和 7160 名年龄和 ADT 治疗指数年与 ADT 组相匹配的男性非 ADT 对照组。使用 Cox 比例风险回归估计 IBS 风险的调整后 HR 和 95%CI。
ADT 组和非 ADT 组的总体 IBS 发生率无显著差异（分别为 0.86 和 0.89/1000 人年，p=0.89）。即使调整了潜在的危险因素，ADT 组发生 IBS 的风险仍为非 ADT 组的 1.06 倍（95%CI 0.62 至 1.82，p=0.82）。此外，我们根据 PC 诊断后 ADT 治疗的时间点对 ADT 队列进行了分层。在 0.77、1.23 和 0.89/1000 人年，早期 ADT、晚期 ADT 和非 ADT 使用者的 IBS 发生率分别为 0.77、1.23 和 0.89/1000 人年；然而，差异无统计学意义。此外，ADT 治疗类型与 IBS 风险之间也没有差异，包括单纯睾丸切除术、单纯黄体生成素释放激素和两者都有。
结果表明，PC 患者接受 ADT 治疗不是 IBS 发生率的独立因素。需要对接受 ADT 治疗的 IBS 患者与 PC 患者进行进一步研究，以获得更大的样本量。
