Gong Jingyi, Payne David, Caron Jesse, Bay Camden P, McGregor Bradley A, Hainer Jon, Partridge Ann H, Neilan Tomas G, Di Carli Marcelo, Nohria Anju, Groarke John D
Heart and Vascular Center, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Center for Clinical Investigation, Brigham and Women's Hospital, Boston, Massachusetts, USA.
JACC CardioOncol. 2020 Nov 17;2(4):553-563. doi: 10.1016/j.jaccao.2020.08.011. eCollection 2020 Nov.
Prolonged androgen deprivation therapy (ADT) is favored over short-term use in patients with localized high-risk prostate cancer (PC).
This study sought to compare cardiorespiratory fitness (CRF) and cardiovascular (CV) mortality among patients with PC with and without ADT exposure and to explore how duration of ADT exposure influences CRF and CV mortality.
Retrospective cohort study of patients referred for exercise treadmill testing (ETT) after a PC diagnosis. PC risk classification was based on Gleason score (GS): high risk if GS ≥8; intermediate risk if GS = 7; and low risk if GS <7. CRF was categorized by metabolic equivalents (METs): METs >8 defined as good CRF and METs ≤8 as reduced CRF. ADT exposure was categorized as short term (≤6 months) versus prolonged (>6 months).
A total of 616 patients underwent an ETT a median of 4.8 years (interquartile range: 2.0, 7.9 years) after PC diagnosis. Of those, 150 patients (24.3%) received ADT prior to the ETT; 99 with short-term and 51 with prolonged exposure. 504 patients (81.8%) had ≥2 CV risk factors. Prolonged ADT was associated with reduced CRF (odds ratio [OR]: 2.71; 95% confidence interval [CI]: 1.31 to 5.61; p = 0.007) and increased CV mortality (hazard ratio [HR]: 3.87; 95% CI: 1.16 to 12.96; p = 0.028) in adjusted analyses. Although the association between short-term ADT exposure and reduced CRF was of borderline significance (OR: 1.71; 95% CI: 1.00 to 2.94; p = 0.052), there was no association with CV mortality (HR: 1.60; 95% CI: 0.51 to 5.01; p = 0.420) in adjusted Cox regression models.
Among patients with PC and high baseline CV risk, prolonged ADT exposure was associated with reduced CRF and increased CV mortality.
对于局限性高危前列腺癌（PC）患者，长期雄激素剥夺治疗（ADT）比短期使用更受青睐。
本研究旨在比较接受和未接受ADT治疗的PC患者的心肺适能（CRF）和心血管（CV）死亡率，并探讨ADT暴露持续时间如何影响CRF和CV死亡率。
对PC诊断后接受运动平板试验（ETT）的患者进行回顾性队列研究。PC风险分类基于 Gleason评分（GS）：GS≥8为高危；GS = 7为中危；GS<7为低危。CRF按代谢当量（METs）分类：METs>8定义为良好的CRF，METs≤8为降低的CRF。ADT暴露分为短期（≤6个月）与长期（>6个月）。
共有616例患者在PC诊断后中位4.8年（四分位间距：2.0，7.9年）接受了ETT。其中，150例患者（24.3%）在ETT前接受了ADT；99例短期暴露，51例长期暴露。504例患者（81.8%）有≥2个CV危险因素。在调整分析中，长期ADT与降低的CRF相关（比值比[OR]：2.71；95%置信区间[CI]：1.31至5.61；p = 0.007）和增加的CV死亡率相关（风险比[HR]：3.87；95%CI：1.16至12.96；p = 0.028）。虽然短期ADT暴露与降低的CRF之间的关联具有临界显著性（OR：1.71；95%CI：1.00至2.94；p = 0.052），但在调整的Cox回归模型中与CV死亡率无关联（HR：1.60；95%CI：0.51至5.01；p = 0.420）。
在具有高基线CV风险的PC患者中，长期ADT暴露与降低的CRF和增加的CV死亡率相关。
