Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Public Health, College of Public health, China Medical University, Taichung, Taiwan.
Cancer. 2021 Jan 1;127(1):124-136. doi: 10.1002/cncr.33203. Epub 2020 Sep 30.
The 23-valent pneumococcal polysaccharide vaccine (PPSV23) is indicated for adults who have a high risk of pneumonia; however, its effectiveness in patients with prostate cancer who are at a risk of pneumonia because of age and cancer treatments, including androgen-deprivation therapy, is unknown.
Between 2000 and 2010, 38,735 patients with prostate cancer were diagnosed in Taiwan. After exclusions and exact matching for age, previous pneumonia, and influenza vaccination, 2188 vaccinated patients and 2188 unvaccinated patients were recruited. The incidence density of all-cause bacterial pneumonia hospitalizations was analyzed.
Over 7 years of follow-up, patients who received the PPSV23 had a significantly lower incidence density, with 142.8 per 1000 person-years versus 162.0 per 1000 person-years for unvaccinated patients. More patients in the vaccinated cohort were never hospitalized for pneumonia compared with those in the unvaccinated cohort (64.2% vs 62.2%, respectively). After adjusting for the Charlson comorbidity index, cancer treatment modalities, and socioeconomic levels, the risk of pneumonia-related hospitalization in the PPSV23 vaccination cohort was 0.48 times lower than that in the unvaccinated cohort (adjusted incidence rate ratio, 0.48; P = .046). For patients who received the influenza vaccination, subgroup analysis demonstrated that PPSV23 vaccination significantly decreased the risk (adjusted incidence rate ratio, 0.45; P < .001). Compared with unvaccinated controls, PPSV23-vaccinated patients had a lower cumulative incidence for the first occurrence of pneumonia-related hospitalization (34.49% vs 36.36%; P = .178) and higher overall survival (47.5% and 42.3%, respectively; P < .001).
Vaccination of elderly patients who have prostate cancer with the relatively common and inexpensive PPSV23 can decrease the risk of pneumonia and prolong survival.
23 价肺炎球菌多糖疫苗（PPSV23）适用于有肺炎高危风险的成年人；然而，对于因年龄和癌症治疗（包括雄激素剥夺治疗）而有肺炎风险的前列腺癌患者，其效果尚不清楚。
2000 年至 2010 年间，在台湾诊断出 38735 例前列腺癌患者。排除年龄、既往肺炎和流感疫苗接种的差异后，并进行精确匹配，共招募了 2188 名接种疫苗的患者和 2188 名未接种疫苗的患者。分析了全因细菌性肺炎住院的发病率密度。
在 7 年的随访期间，接受 PPSV23 疫苗接种的患者发病率密度显著降低，接种患者的每 1000 人年为 142.8 例，而未接种患者的每 1000 人年为 162.0 例。与未接种疫苗组相比，接种组中有更多的患者从未因肺炎住院（分别为 64.2%和 62.2%）。在校正 Charlson 合并症指数、癌症治疗方式和社会经济水平后，PPSV23 疫苗接种组肺炎相关住院的风险降低了 0.48 倍（校正发病率比，0.48；P =.046）。对于接受流感疫苗接种的患者，亚组分析表明，PPSV23 疫苗接种显著降低了风险（校正发病率比，0.45；P <.001）。与未接种对照组相比，PPSV23 疫苗接种患者首次发生肺炎相关住院的累积发生率较低（34.49%比 36.36%；P =.178），总生存率较高（分别为 47.5%和 42.3%；P <.001）。
为有前列腺癌的老年患者接种相对常见且廉价的 PPSV23 可以降低肺炎风险并延长生存期。
