Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Division of Urological Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
J Urol. 2018 Jun;199(6):1417-1425. doi: 10.1016/j.juro.2017.11.136. Epub 2018 Feb 2.
Use of androgen deprivation therapy may increase the risk of cognitive impairment in men with prostate cancer. We performed a systematic review of the risk of overall cognitive impairment as an outcome in men receiving androgen deprivation therapy for prostate cancer.
Studies were identified through PubMed®, MEDLINE®, PsycINFO®, Cochrane Library and Web of Knowledge/Science™. Articles were included if they 1) were published in English, 2) had subjects treated for prostate cancer with androgen deprivation therapy, 3) incorporated longitudinal comparisons and 4) used control groups. In addition, prospective studies were required to assess an established cognitive related end point using International Cognition and Cancer Task Force criteria defining impaired cognitive performance as scoring 1.5 or more standard deviations below published norms on 2 or more tests, or scoring 2.0 or more standard deviations below published norms on at least 1 test. The effect of androgen deprivation therapy on cognitive impairment was pooled using a random effects model.
Of 221 abstracts 26 were selected for full text review, and 2 prospective and 4 retrospective studies were analyzed. Androgen deprivation therapy was not associated with overall cognitive impairment when the prospective cohort studies were pooled (OR 1.57, 95% CI 0.50 to 4.92, p = 0.44) with significant heterogeneity between estimates (I = 83%). In retrospective data the relative risk of any cognitive impairment, including senile dementia and Alzheimer disease, was increased in men receiving androgen deprivation therapy, although the difference was not statistically significant (HR 1.28, 95% CI 0.93 to 1.76, p = 0.13) with moderate heterogeneity between estimates (I = 67%).
Analyses between overall cognitive impairment and use of androgen deprivation therapy defined according to International Cognition and Cancer Task Force criteria in a pooled analysis were inconclusive. In retrospective cohort studies the risk of overall cognitive impairment after androgen deprivation therapy was not significant. Better prospective studies need to be designed for the assessment of this end point.
雄激素剥夺疗法的使用可能会增加前列腺癌男性认知障碍的风险。我们对接受雄激素剥夺疗法治疗前列腺癌的男性作为结局的整体认知障碍风险进行了系统评价。
通过 PubMed®、MEDLINE®、PsycINFO®、Cochrane 图书馆和 Web of Knowledge/Science™ 确定研究。如果文章符合以下标准，则被纳入：1）发表于英文期刊，2）研究对象接受雄激素剥夺疗法治疗前列腺癌，3）包含纵向比较，4）使用对照组。此外，前瞻性研究需要使用国际认知与癌症协作组标准评估已建立的认知相关终点，该标准将认知表现受损定义为在 2 项或以上测试中得分低于发表的常模 1.5 个标准差或以上，或在至少 1 项测试中得分低于发表的常模 2.0 个标准差或以上。使用随机效应模型汇总雄激素剥夺疗法对认知障碍的影响。
在 221 篇摘要中，有 26 篇被选入全文审查，有 2 项前瞻性研究和 4 项回顾性研究被分析。当汇总前瞻性队列研究时，雄激素剥夺疗法与整体认知障碍无关（OR 1.57，95%CI 0.50 至 4.92，p = 0.44），但估计值之间存在显著异质性（I = 83%）。在回顾性数据中，接受雄激素剥夺疗法的男性发生任何认知障碍（包括老年痴呆症和阿尔茨海默病）的相对风险增加，但差异无统计学意义（HR 1.28，95%CI 0.93 至 1.76，p = 0.13），估计值之间存在中度异质性（I = 67%）。
根据国际认知与癌症协作组标准，对整体认知障碍和雄激素剥夺疗法的使用进行汇总分析的结果尚无定论。在回顾性队列研究中，雄激素剥夺疗法后整体认知障碍的风险不显著。需要设计更好的前瞻性研究来评估这一终点。
