雄激素剥夺疗法对新冠肺炎前列腺癌患者死亡率的影响：一项基于倾向评分的分析。
Impact of androgen deprivation therapy on mortality of prostate cancer patients with COVID-19: a propensity score-based analysis.
作者信息
Duarte Mateus Bringel Oliveira, Leal Frederico, Argenton Juliana Luz Passos, Carvalheira José Barreto Campello
机构信息
Division of Oncology, Department of Anesthesiology, Oncology and Radiology, School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil.
Uberlândia Cancer Hospital, Federal University of Uberlândia, UFU, Uberlândia, MG, Brazil.
出版信息
Infect Agent Cancer. 2021 Nov 25;16(1):66. doi: 10.1186/s13027-021-00406-y.
BACKGROUND
Previous studies hypothesized that androgen deprivation therapy (ADT) may reduce severe acute respiratory syndrome coronavirus 2 (SARS-COV2) infectivity. However, it is unknown whether there is an association between ADT and a higher survival in prostate cancer patients with COVID-19.
METHODS
We performed a retrospective analysis of prostate cancer (PC) patients hospitalized to treat COVID-19 in Brazil's public health system. We compared patients with the active use of ADT versus those with non-active ADT, past use. We constructed propensity score models of patients in active versus non-active use of ADT. All variables were used to derive propensity score estimation in both models. In the first model we performed a pair-matched propensity score model between those under active and non-active use of ADT. To the second model we initially performed a multivariate backward elimination process to select variables to a final inverse-weight adjusted with double robust estimation model.
RESULTS
We analyzed 199 PC patients with COVID-19 that received ADT. In total, 52.3% (95/199) of our patients were less than 75 years old, 78.4% (156/199) were on active ADT, and most were using a GnRH analog (80.1%; 125/156). Most of patients were in palliative treatment (89.9%; 179/199). Also, 63.3% of our cohort died from COVID-19. Forty-eight patients under active ADT were pair matched against 48 controls (non-active ADT). All patients (199) were analyzed in the double robust model. ADT active use were not protective factor in both inverse-weight based propensity score (OR 0.70, 95% CI 0.38-1.31, P = 0.263), and pair-matched propensity score (OR 0.67, 95% CI 0.27-1.63, P = 0.374) models. We noticed a significant imbalance in the propensity score of patients in active and those in non-active ADT, with important reductions in the differences after the adjustments.
CONCLUSIONS
The active use of ADT was not associated with a reduced risk of death in patients with COVID-19.
背景
既往研究推测雄激素剥夺疗法（ADT）可能会降低严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的传染性。然而，ADT与新冠肺炎前列腺癌患者更高的生存率之间是否存在关联尚不清楚。
方法
我们对巴西公共卫生系统中因新冠肺炎住院治疗的前列腺癌（PC）患者进行了一项回顾性分析。我们比较了正在使用ADT的患者与过去使用过ADT（非正在使用）的患者。我们构建了正在使用与未正在使用ADT患者的倾向评分模型。所有变量均用于两个模型中倾向评分的估计。在第一个模型中，我们在正在使用和未正在使用ADT的患者之间进行了配对倾向评分模型分析。在第二个模型中，我们首先进行了多变量向后消除过程，以选择变量，最终得到一个采用双重稳健估计模型进行逆加权调整的模型。
结果
我们分析了199例接受ADT治疗的新冠肺炎PC患者。总体而言，我们的患者中有52.3%（95/199）年龄小于75岁，78.4%（156/199）正在接受ADT治疗，且大多数患者使用促性腺激素释放激素类似物（80.1%；125/156）。大多数患者接受姑息治疗（89.9%；179/199）。此外，我们队列中的63.3%患者死于新冠肺炎。48例正在接受ADT治疗的患者与48例对照（未正在使用ADT）进行配对。在双重稳健模型中对所有199例患者进行了分析。在基于逆加权的倾向评分模型（OR 0.70，95%CI 0.38 - 1.31，P = 0.263）和配对倾向评分模型（OR 0.67，95%CI 0.27 - 1.63，P = 0.374）中，正在使用ADT均不是保护因素。我们注意到正在使用和未正在使用ADT患者的倾向评分存在显著不平衡，调整后差异有重要降低。
结论
正在使用ADT与新冠肺炎患者死亡风险降低无关。
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