Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Medicine, Weill Cornell Medical Center, New York, NY, USA.
JNCI Cancer Spectr. 2022 May 2;6(3). doi: 10.1093/jncics/pkac035.
TMPRSS2, a cell surface protease regulated by androgens and commonly upregulated in prostate cancer (PCa), is a necessary component for SARS-CoV-2 viral entry into respiratory epithelial cells. Previous reports suggested a lower risk of SARS-CoV-2 among PCa patients on androgen deprivation therapy (ADT). However, the impact of ADT on severe COVID-19 illness is poorly understood.
We performed a multicenter study across 7 US medical centers and evaluated patients with PCa and SARS-CoV-2 detected by polymerase-chain-reaction between March 1, 2020, and May 31, 2020. PCa patients were considered on ADT if they had received appropriate ADT treatment within 6 months of COVID-19 diagnosis. We used multivariable logistic and Cox proportional-hazard regression models for analysis. All statistical tests were 2-sided.
We identified 465 PCa patients (median age = 71 years) with a median follow-up of 60 days. Age, body mass index, cardiovascular comorbidity, and PCa clinical disease state adjusted overall survival (hazard ratio [HR] = 1.16, 95% confidence interval [CI] = 0.68 to 1.98, P = .59), hospitalization status (HR = 0.96, 95% CI = 0.52 to 1.77, P = .90), supplemental oxygenation (HR 1.14, 95% CI = 0.66 to 1.99, P = .64), and use of mechanical ventilation (HR = 0.81, 95% CI = 0.25 to 2.66, P = .73) were similar between ADT and non-ADT cohorts. Similarly, the addition of androgen receptor-directed therapy within 30 days of COVID-19 diagnosis to ADT vs ADT alone did not statistically significantly affect overall survival (androgen receptor-directed therapy: HR = 1.27, 95% CI = 0.69 to 2.32, P = .44).
In this retrospective cohort of PCa patients, the use of ADT was not demonstrated to influence severe COVID-19 outcomes, as defined by hospitalization, supplemental oxygen use, or death. Age 70 years and older was statistically significantly associated with a higher risk of developing severe COVID-19 disease.
TMPRSS2 是一种受雄激素调节并在前列腺癌（PCa）中普遍上调的细胞表面蛋白酶，是 SARS-CoV-2 病毒进入呼吸道上皮细胞的必要组成部分。先前的报告表明，接受雄激素剥夺疗法（ADT）的 PCa 患者感染 SARS-CoV-2 的风险较低。然而，ADT 对严重 COVID-19 疾病的影响尚不清楚。
我们在 7 家美国医疗中心进行了一项多中心研究，并评估了 2020 年 3 月 1 日至 2020 年 5 月 31 日期间通过聚合酶链反应检测到的患有 PCa 和 SARS-CoV-2 的患者。如果 PCa 患者在 COVID-19 诊断后 6 个月内接受了适当的 ADT 治疗，则认为他们正在接受 ADT。我们使用多变量逻辑和 Cox 比例风险回归模型进行分析。所有统计检验均为双侧。
我们确定了 465 名 PCa 患者（中位年龄为 71 岁），中位随访时间为 60 天。年龄、体重指数、心血管合并症和 PCa 临床疾病状态调整后的总体生存率（风险比 [HR] = 1.16，95%置信区间 [CI] = 0.68 至 1.98，P = 0.59）、住院状态（HR = 0.96，95%CI = 0.52 至 1.77，P = 0.90）、补充氧气（HR 1.14，95%CI = 0.66 至 1.99，P = 0.64）和机械通气的使用（HR = 0.81，95%CI = 0.25 至 2.66，P = 0.73）在 ADT 和非 ADT 队列之间相似。同样，在 COVID-19 诊断后 30 天内添加雄激素受体靶向治疗与 ADT 相比并未显着影响总体生存率（雄激素受体靶向治疗：HR = 1.27，95%CI = 0.69 至 2.32，P = 0.44）。
在这项针对 PCa 患者的回顾性队列研究中，没有发现 ADT 的使用会影响住院、使用补充氧气或死亡等定义的严重 COVID-19 结局。70 岁及以上的年龄与发生严重 COVID-19 疾病的风险增加呈统计学显著相关。
