Division of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
Department of Biological Science and Technology, Chung Hwa University of Medical Technology, Tainan, Taiwan.
J Urol. 2022 Apr;207(4):841-850. doi: 10.1097/JU.0000000000002340. Epub 2021 Dec 2.
Androgen deprivation therapy (ADT) includes bilateral orchiectomy or long-acting gonadotropin-releasing hormone (GnRH) agonists/antagonists. It remains controversial with respect to ADT associated cardiovascular outcomes. Hereby, we compared the risk of major adverse cardiovascular and cerebrovascular events (MACCEs) in patients with prostate cancer receiving either surgical castration or GnRH therapies.
Using the Taiwan Cancer Registry and Taiwan's National Health Insurance Research Database, we identified 8,413 patients receiving GnRH therapies compared with 694 receiving surgical castration from 2008 to 2017. The median followup duration was 3 years.
The crude incidences of 3-year mortality and MACCEs were 19.90% vs 26.51% and 8.23% vs 8.65% in patients receiving GnRH therapies or surgical castration, respectively. After adjusting for age, cancer stage and comorbidities, despite no significant differences in MACCEs between groups there was a slight increase in the incidence of acute myocardial infarction (AMI) in patients receiving surgical castration compared with those receiving GnRH therapies. The mortality adjusted hazard ratios of MACCEs and AMI among patients receiving surgical castration were 1.11- and 1.8-fold higher than those receiving GnRH therapies. Notably, in subgroup analysis regarding cancer stage, patients with cancer stage IV showed the most significantly increasing risk of AMI in those receiving surgical castration compared with GnRH therapies.
Collectively, we indicated an increased risk of AMI in patients with prostate cancer, especially in patients receiving surgical castration rather than those receiving GnRH therapies. Our findings highlight concerns regarding the cardiac safety of surgical castration compared with GnRH therapies.
雄激素剥夺疗法（ADT）包括双侧睾丸切除术或长效促性腺激素释放激素（GnRH）激动剂/拮抗剂。ADT 相关心血管结局仍存在争议。在此，我们比较了接受手术去势或 GnRH 治疗的前列腺癌患者发生主要不良心血管和脑血管事件（MACCEs）的风险。
使用台湾癌症登记处和台湾全民健康保险研究数据库，我们从 2008 年至 2017 年确定了 8413 例接受 GnRH 治疗的患者和 694 例接受手术去势的患者。中位随访时间为 3 年。
接受 GnRH 治疗或手术去势的患者 3 年死亡率和 MACCEs 的粗发生率分别为 19.90%比 26.51%和 8.23%比 8.65%。在调整年龄、癌症分期和合并症后，尽管两组间 MACCEs 无显著差异，但接受手术去势的患者急性心肌梗死（AMI）发生率略有增加。接受手术去势的患者 MACCEs 和 AMI 的死亡率调整后危险比分别为接受 GnRH 治疗的 1.11 倍和 1.8 倍。值得注意的是，在癌症分期的亚组分析中，IV 期癌症患者接受手术去势的 AMI 风险比接受 GnRH 治疗的患者显著增加。
总的来说，我们发现前列腺癌患者接受手术去势的 AMI 风险增加，尤其是接受手术去势的患者，而接受 GnRH 治疗的患者则风险较低。我们的研究结果突显了与 GnRH 治疗相比，手术去势对心脏安全性的担忧。
