Division of Urology, Department of Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan.
Department of Medicine, National Yang-Ming University, Taipei, Taiwan.
PLoS One. 2020 Feb 19;15(2):e0229263. doi: 10.1371/journal.pone.0229263. eCollection 2020.
This study aimed to investigate the association between androgen deprivation therapy (ADT) and the risk of subsequently developing hematologic disorders in patients with prostate cancer.
This population-based nationwide cohort study utilized data from the Taiwan National Health Insurance Research Database between 1997 and 2013. The patients were divided into three groups-those who received ADT only (ADT-only group), those who had radiotherapy (RT) only (RT-only group), and those treated with radical prostatectomy (RP) only (RP-only group). The study outcome was newly diagnosed hematologic disorder, including anemia and hematologic malignancy. Propensity score-matched, Cox regression, and Kaplan-Meier curve analyses were performed to investigate the risk of subsequently developing hematologic disorders after ADT.
Of the 17,168 patients with prostate cancer who were included in the study, 13,318 met the inclusion and exclusion criteria. After propensity score matching, 1,797, 1,797, and 1,797 patients treated with ADT only, RT only, and RP only, respectively, who had a median follow-up period of 4.32 years were included in the study cohort. Compared with the patients treated with RP only, those who received ADT and RT were significantly at increased risk of subsequently developing hematologic disorders (ADT: adjusted hazard ratio [aHR]: 1.60, 95% confidence interval [CI]: 1.29-1.97; RT: aHR, 1.98, 95% CI: 1.62-2.42) according to the Cox regression analysis. Based on the Kaplan-Meier curve analysis, patients with bone metastasis who received ADT only had the lowest cumulative probabilities of not developing hematologic disorders. Moreover, a significantly increased risk of hematologic disorders was observed with the increasing duration of ADT (P for trend < .001).
The use of ADT in patients with prostate cancer may increase the risk of subsequently developing hematologic disorders.
本研究旨在探讨雄激素剥夺疗法（ADT）与前列腺癌患者随后发生血液系统疾病的风险之间的关系。
本基于人群的全国性队列研究使用了 1997 年至 2013 年期间来自台湾全民健康保险研究数据库的数据。患者分为三组：仅接受 ADT 治疗的患者（ADT 组）、仅接受放疗（RT）治疗的患者（RT 组）和仅接受根治性前列腺切除术（RP）治疗的患者（RP 组）。研究结果为新发血液系统疾病，包括贫血和血液系统恶性肿瘤。采用倾向评分匹配、Cox 回归和 Kaplan-Meier 曲线分析来研究 ADT 后发生血液系统疾病的风险。
在纳入研究的 17168 例前列腺癌患者中，有 13318 例符合纳入和排除标准。经过倾向评分匹配后，分别有 1797、1797 和 1797 例仅接受 ADT、仅接受 RT 和仅接受 RP 治疗的患者纳入研究队列，中位随访时间为 4.32 年。与仅接受 RP 治疗的患者相比，接受 ADT 和 RT 治疗的患者随后发生血液系统疾病的风险显著增加（ADT：调整后的危险比 [aHR]：1.60，95%置信区间 [CI]：1.29-1.97；RT：aHR：1.98，95% CI：1.62-2.42），这是根据 Cox 回归分析得出的结果。根据 Kaplan-Meier 曲线分析，仅接受 ADT 治疗且有骨转移的患者发生血液系统疾病的累积概率最低。此外，随着 ADT 持续时间的增加，发生血液系统疾病的风险显著增加（P 趋势<.001）。
在前列腺癌患者中使用 ADT 可能会增加随后发生血液系统疾病的风险。
