Nead Kevin T, Boldbaatar Ninjin, Yang David D, Sinha Sumi, Nguyen Paul L
Department of Radiation Oncology, Perelman Center for Advanced Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Urology. 2018 Apr;114:155-162. doi: 10.1016/j.urology.2017.11.055. Epub 2018 Jan 17.
To investigate the association of androgen deprivation therapy (ADT) for prostate cancer with thromboembolic events.
PubMed, Web of Science, and Scopus were queried on April 5, 2017 for systematic review. Additionally, The World Health Organization International Trials Registry Platform was queried on June 23, 2017. Eligible studies reported thromboembolic events among individuals with prostate cancer exposed to ADT vs a lesser-exposed group. Five hundred sixty-nine unique studies were identified with 65 undergoing full-text review. We utilized the Meta-analysis of Observational Studies in Epidemiology statement guidelines and the Cochrane Review Group's data extraction template. Study quality was evaluated by Newcastle-Ottawa Scale criteria. We conducted random-effects meta-analyses to calculate summary statistic risk ratios and 95% confidence intervals. Heterogeneity was quantified using the I statistic. Small study effects were evaluated using Begg and Egger statistics.
In 10 studies "ADT without estrogen" increased the risk of thromboembolic events (risk ratio [RR] 1.43, 95% confidence interval [CI] 1.15-1.77, P = .001). In 9 studies estrogen therapy alone was associated with an increased risk of thromboembolic events (RR 3.72, 95% CI 1.78-7.80, P <.001). We found an increased risk of thromboembolic events from ADT use without estrogen when limited to localized disease (RR 1.10, 95% CI 1.05-1.16, P <.001). Heterogeneity was resolved in those studies examining localized disease. There was no evidence of small study effects.
The currently available evidence suggests that ADT without estrogen is associated with an increased the risk of thromboembolic events.
探讨前列腺癌雄激素剥夺治疗（ADT）与血栓栓塞事件之间的关联。
于2017年4月5日检索PubMed、Web of Science和Scopus数据库以进行系统评价。此外，于2017年6月23日检索世界卫生组织国际临床试验注册平台。符合条件的研究报告了前列腺癌患者中接受ADT治疗组与暴露较少组的血栓栓塞事件。共识别出569项独特研究，其中65项进行了全文审查。我们采用了流行病学观察性研究的Meta分析声明指南和Cochrane综述组的数据提取模板。研究质量通过纽卡斯尔-渥太华量表标准进行评估。我们进行随机效应Meta分析以计算汇总统计风险比和95%置信区间。使用I统计量对异质性进行量化。使用Begg和Egger统计量评估小研究效应。
在10项研究中，“无雌激素的ADT”增加了血栓栓塞事件的风险（风险比[RR]为1.43，95%置信区间[CI]为1.15 - 1.77，P = 0.001）。在9项研究中，单独使用雌激素治疗与血栓栓塞事件风险增加相关（RR为3.72，95% CI为1.78 - 7.80，P < 0.001）。当仅限于局限性疾病时，我们发现无雌激素的ADT使用会增加血栓栓塞事件的风险（RR为1.10，95% CI为1.05 - 1.16，P < 0.001）。在那些研究局限性疾病的研究中异质性得到了解决。没有小研究效应的证据。
目前可得的证据表明，无雌激素的ADT与血栓栓塞事件风险增加相关。
