Bosco Cecilia, Wong Chloe, Garmo Hans, Crawley Danielle, Holmberg Lars, Hammar Niklas, Adolfsson Jan, Stattin Pär, Van Hemelrijck Mieke
School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research, King's College London, London, UK.
Regional Cancer Centre, Uppsala University, Uppsala, Sweden.
BJU Int. 2018 Feb;121(2):260-267. doi: 10.1111/bju.14023. Epub 2017 Oct 17.
To evaluate whether drugs for metabolic conditions influence prostate cancer-specific mortality in men starting gonadotrophin-releasing hormone (GnRH) agonists, as it is unclear whether metabolic syndrome and its related drugs is affecting treatment response in men with prostate cancer on GnRH agonists.
We selected all men receiving GnRH agonists as primary treatment in the Prostate Cancer data Base Sweden (PCBaSe) (n = 9267). Use of drugs for metabolic conditions (i.e. anti-diabetes, anti-dyslipidaemia, and antihypertension) in relation to all-cause, cardiovascular disease (CVD), and prostate cancer-specific death were studied using multivariate Cox proportional hazard and Fine and Gray competing regression models.
In all, 6322 (68%) men used at least one drug for a metabolic condition at GnRH agonist initiation: 46% on antihypertensive drugs only, 32% on drugs for dyslipidaemia and hypertension, and ~10% on drugs for more than two metabolic conditions. Cox models indicated a weak increased risk of prostate cancer death in men who were on drugs for hypertension only (hazard ratio [HR] 1.12, 95% confidence interval [CI] 1.03-1.23) or drugs for hyperglycaemia (HR 1.19, 95% CI 1.06-1.35) at GnRH agonist initiation. However, upon taking into account competing risk from CVD death, none of the drugs for metabolic conditions were associated with an increased risk of prostate cancer death.
We did not find evidence for a better or worse response to GnRH agonists in men with prostate cancer who were also on drugs for hypertension, dyslipidaemia, or hyperglycaemia.
评估用于代谢性疾病的药物是否会影响开始使用促性腺激素释放激素（GnRH）激动剂的男性的前列腺癌特异性死亡率，因为尚不清楚代谢综合征及其相关药物是否会影响接受GnRH激动剂治疗的前列腺癌男性的治疗反应。
我们在瑞典前列腺癌数据库（PCBaSe）中选择了所有接受GnRH激动剂作为主要治疗的男性（n = 9267）。使用多变量Cox比例风险模型和Fine and Gray竞争回归模型研究了用于代谢性疾病的药物（即抗糖尿病药、抗血脂异常药和抗高血压药）与全因死亡、心血管疾病（CVD）和前列腺癌特异性死亡之间的关系。
总共有6322名（68%）男性在开始使用GnRH激动剂时使用了至少一种用于代谢性疾病的药物：仅使用抗高血压药物的占46%，使用血脂异常和高血压药物的占32%，使用两种以上代谢性疾病药物的约占10%。Cox模型表明，在开始使用GnRH激动剂时仅使用抗高血压药物（风险比[HR] 1.12，95%置信区间[CI] 1.03 - 1.23）或高血糖药物（HR 1.19，95% CI ）的男性中，前列腺癌死亡风险略有增加。然而，在考虑到CVD死亡的竞争风险后，没有一种用于代谢性疾病的药物与前列腺癌死亡风险增加相关。
我们没有发现证据表明，同时使用抗高血压药、抗血脂异常药或高血糖药的前列腺癌男性对GnRH激动剂的反应更好或更差。
