Harvard Radiation Oncology Program, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts.
Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts.
Cancer. 2018 Apr 1;124(7):1391-1399. doi: 10.1002/cncr.31217. Epub 2018 Jan 16.
Herein, the authors evaluated how the time to testosterone rebound (TTR) after radiotherapy (RT) and 6 months of androgen deprivation therapy (ADT) impacted the risk of prostate cancer-specific mortality (PCSM) and cardiovascular-specific mortality (CVM) among men with varying comorbidity extent.
Between 1995 and 2001, a total of 206 men who were randomized to receive RT either alone or with 6 months of ADT for unfavorable-risk PC and who had a comorbidity score assigned using the Adult Comorbidity Evaluation 27 metric comprised the study cohort. Multivariable competing risk regression was used to evaluate the impact of and possible interaction between comorbidity and TTR on PCSM and CVM.
After a median follow-up of 18.19 years, 30 men (18.6%), 39 men (24.2%), and 92 men (57.1%), respectively, had died of PC, CV disease, or other causes. As TTR increased, PCSM significantly decreased in men with no or minimal (adjusted hazard ratio [AHR], 0.53, 95% confidence interval [95% CI], 0.34-0.84 [P =.007]) and moderate to severe (AHR, 0.37; 95% CI, 0.14-0.99 [P = .048]) comorbidity. However, increasing TTR significantly increased the risk of CVM among men with moderate to severe comorbidity (AHR, 1.87; 95% CI, 1.40-2.49 [P <.001]), but not those with no or minimal comorbidity (AHR, 0.86; 95% CI, 0.57-1.29 [P =.46]), leading to a significant interaction between TTR and comorbidity (P = .001).
The results of the current study indicate that considering an intermittent course of ADT such that the TTR approaches 18 months, instead of continuous long-term administration of ADT, in men with moderate to severe comorbidity and high-risk PC may reduce the increased risk of CVM without increasing the risk of PCSM. Cancer 2018;124:1391-9. © 2018 American Cancer Society.
在此，作者评估了放疗（RT）和 6 个月雄激素剥夺治疗（ADT）后睾酮反弹时间（TTR）对不同合并症程度的男性前列腺癌特异性死亡率（PCSM）和心血管特异性死亡率（CVM）风险的影响。
1995 年至 2001 年，共有 206 名患者被随机分配接受 RT 治疗或联合 6 个月 ADT 治疗，这些患者患有不利风险的前列腺癌且具有使用成人合并症评估 27 量表评估的合并症评分。采用多变量竞争风险回归评估合并症和 TTR 对 PCSM 和 CVM 的影响及其可能的相互作用。
中位随访 18.19 年后，分别有 30 名男性（18.6%）、39 名男性（24.2%）和 92 名男性（57.1%）死于前列腺癌、心血管疾病或其他原因。随着 TTR 的增加，无或轻度合并症（调整后的危险比 [AHR]，0.53；95%置信区间 [95%CI]，0.34-0.84[P =.007]）和中重度合并症（AHR，0.37；95%CI，0.14-0.99[P =.048]）男性的 PCSM 显著降低。然而，TTR 的增加显著增加了中重度合并症男性发生 CVM 的风险（AHR，1.87；95%CI，1.40-2.49[P <.001]），但对无或轻度合并症男性则没有（AHR，0.86；95%CI，0.57-1.29[P =.46]），这导致 TTR 和合并症之间存在显著的交互作用（P =.001）。
本研究结果表明，对于中重度合并症和高危前列腺癌患者，考虑采用间歇性 ADT 方案，使 TTR 接近 18 个月，而不是连续长期应用 ADT，可能会降低 CVM 的风险增加，而不会增加 PCSM 的风险。癌症 2018；124：1391-9. © 2018 美国癌症协会。
