Center for Surgery and Public Health, Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Center for Surgery and Public Health, Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
J Urol. 2018 Sep;200(3):573-581. doi: 10.1016/j.juro.2018.03.135. Epub 2018 Apr 16.
Androgen deprivation therapy is associated with the development of diabetes and metabolic syndrome. To our knowledge its effect on the development of nonalcoholic fatty liver disease, a condition which frequently co-occurs with metabolic syndrome and other subsequent liver conditions such as liver cirrhosis, hepatic necrosis or any liver disease, has not been investigated.
We identified 82,938 men 66 years old or older who were diagnosed with localized prostate cancer in the SEER (Surveillance, Epidemiology and End Results)-Medicare database from 1992 to 2009. Men with preexisting nonalcoholic fatty liver disease, liver disease, diabetes or metabolic syndrome were excluded from study. Propensity score adjusted, competing risk regression models were created to compare the risk of nonalcoholic fatty liver disease in men who were vs were not treated with androgen deprivation. We also explored the influence of cumulative exposure to androgen deprivation therapy, calculated as monthly equivalent doses of gonadotropin-releasing hormone agonists/antagonists (fewer than 7, 7 to 11 or more than 11 doses).
Overall 37.5% of men underwent androgen deprivation therapy. They were more likely to be diagnosed with nonalcoholic fatty liver disease (HR 1.54, 95% CI 1.40-1.68), liver cirrhosis (HR 1.35, 95% CI 1.12-1.60), liver necrosis (HR 1.41, 95% CI 1.15-1.72) and any liver disease (HR 1.47, 95% CI 1.35-1.60). A dose-response relationship was observed between the number of androgen deprivation therapy doses, and nonalcoholic fatty liver disease and any liver disease.
Androgen deprivation therapy in men with prostate cancer is associated with the diagnosis of nonalcoholic fatty liver disease. The usual limitations of an observational study design apply, including possible inaccuracy in defining outcomes in a population based registry.
雄激素剥夺疗法与糖尿病和代谢综合征的发展有关。据我们所知，它对非酒精性脂肪性肝病的发展的影响尚未得到研究，这种疾病常与代谢综合征和其他后续的肝脏疾病如肝硬化、肝坏死或任何肝脏疾病同时发生。
我们从 1992 年至 2009 年在 SEER（监测、流行病学和最终结果）-医疗保险数据库中确定了 82938 名 66 岁或以上被诊断为局限性前列腺癌的男性。患有非酒精性脂肪性肝病、肝脏疾病、糖尿病或代谢综合征的男性被排除在研究之外。采用倾向评分调整的竞争风险回归模型比较了接受雄激素剥夺治疗的男性与未接受雄激素剥夺治疗的男性患非酒精性脂肪性肝病的风险。我们还探讨了雄激素剥夺治疗累积暴露的影响，计算方法为促性腺激素释放激素激动剂/拮抗剂的月等效剂量（少于 7、7-11 或多于 11 剂）。
总体而言，37.5%的男性接受了雄激素剥夺治疗。他们更有可能被诊断为非酒精性脂肪性肝病（HR 1.54，95%CI 1.40-1.68）、肝硬化（HR 1.35，95%CI 1.12-1.60）、肝坏死（HR 1.41，95%CI 1.15-1.72）和任何肝脏疾病（HR 1.47，95%CI 1.35-1.60）。观察到雄激素剥夺治疗剂量与非酒精性脂肪性肝病和任何肝脏疾病之间存在剂量反应关系。
前列腺癌男性的雄激素剥夺治疗与非酒精性脂肪性肝病的诊断有关。通常适用于观察性研究设计的限制，包括在基于人群的登记处定义结局可能不准确。
