Dong-Yi Chen, Lai-Chu See, Jia-Rou Liu, Cheng-Keng Chuang, See-Tong Pang, I-Chang Hsieh, Ming-Shien Wen, Yung-Chang Lin, Chuang-Chi Liaw, Cheng-Lung Hsu, John Wen-Cheng Chang, Chang-Fu Kuo and Wen-Kuan Huang, Chang Gung Memorial Hospital, Linkou, Chang Gung University College of Medicine; Taoyuan; Tien-Hsing Chen, Chang Gung Memorial Hospital, Keelung, Taiwan; and Wen-Kuan Huang, Karolinska Institutet, Stockholm, Sweden.
J Clin Oncol. 2017 Nov 10;35(32):3697-3705. doi: 10.1200/JCO.2016.71.4204. Epub 2017 Oct 2.
Purpose Our aim was to determine whether cardiovascular (CV) risk in patients with prostate cancer (PCa) differs between those who receive androgen-deprivation therapy by surgical castration and those who receive gonadotropin-releasing hormone agonist (GnRHa) therapy. Patients and Methods By using the Taiwan National Health Insurance Research Database, we analyzed data from 14,715 patients with PCa diagnosed from January 1, 1997, through December 31, 2011. The patients were treated with bilateral orchiectomy or GnRHa therapy. We used inverse probability of treatment weighting with propensity scores to adjust for the imbalance in covariate baseline values between these two groups. Cox regression models were used to identify risk factors for myocardial infarction (MI), ischemic stroke (IS), and cardiac-related complications. Results Overall, 3,578 patients with PCa (24.3%) underwent bilateral orchiectomy and 11,137 patients (75.7%) received GnRHa therapy. Both groups had a similar risk of CV ischemic events (ie, MI or IS; hazard ratio, 1.16; 95% CI, 0.97 to 1.38) during a median follow-up time of 3.3 years. However, during the first 1.5 years of follow-up, there were higher CV ischemic events in the orchiectomy group than in the GnRHa group (hazard ratio, 1.40; 95% CI, 1.04 to 1.88), particularly in patients who were ≥ 65 years of age, had hypertension, had a Charlson comorbidity index score ≥ 3, and had a previous history of MI, IS, or coronary heart disease. Conclusion Compared with bilateral orchiectomy, use of GnRHa does not increase the risk of CV ischemic events in patients with PCa. Nonetheless, orchiectomy is associated with higher rates of CV ischemic events in older patients and those with a history of CV comorbidities within 1.5 years of initiating androgen-deprivation therapy. These findings can help clinicians decide on the optimal castration strategy for individual patients.
本研究旨在确定接受手术去势或促性腺激素释放激素激动剂（GnRHa）治疗的前列腺癌（PCa）患者的心血管（CV）风险是否存在差异。
通过使用台湾全民健康保险研究数据库，我们分析了 1997 年 1 月 1 日至 2011 年 12 月 31 日期间诊断为 PCa 的 14715 例患者的数据。这些患者接受了双侧睾丸切除术或 GnRHa 治疗。我们使用倾向评分逆概率治疗加权法来调整两组间协变量基线值的不平衡。使用 Cox 回归模型来确定心肌梗死（MI）、缺血性卒中和心脏相关并发症的风险因素。
共有 3578 例 PCa 患者（24.3%）接受了双侧睾丸切除术，11137 例患者（75.7%）接受了 GnRHa 治疗。两组患者在中位随访 3.3 年期间的 CV 缺血事件（即 MI 或 IS）风险相似（危险比，1.16；95%CI，0.97 至 1.38）。然而，在随访的前 1.5 年，睾丸切除术组的 CV 缺血事件发生率高于 GnRHa 组（危险比，1.40；95%CI，1.04 至 1.88），尤其是年龄≥65 岁、患有高血压、Charlson 合并症指数评分≥3 以及有 MI、IS 或冠心病既往史的患者。
与双侧睾丸切除术相比，GnRHa 治疗不会增加 PCa 患者 CV 缺血事件的风险。然而，在开始去势治疗的 1.5 年内，睾丸切除术与老年患者和合并 CV 疾病的患者的 CV 缺血事件发生率较高相关。这些发现可以帮助临床医生为个体患者决定最佳去势策略。
