Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.
Division of the Surgical Intensive Care Unit, Department of Intensive Care, Taichung Veterans General Hospital, Taichung, Taiwan.
PLoS One. 2022 Jun 28;17(6):e0270292. doi: 10.1371/journal.pone.0270292. eCollection 2022.
Androgen Deprivation Therapy (ADT) is the mainstay treatment in advanced prostate cancer. We conducted a nationwide population-based study to evaluate the association of ADT and cardiovascular diseases.
Between 2005 and 2009, patient data from the National Health Insurance database were obtained. We divided newly diagnosed prostate cancer patients into four groups, injection of gonadotropin-releasing hormone agonists and antagonists, oral antiandrogens, orchiectomy and radical prostatectomy only. Another matched non-cancerous control group was also assigned for comparison purposes. Study outcomes were newly onset Cardiovascular Diseases (CVD) and hospital admissions. Multi-variant Cox proportional regression analysis and the Kaplan-Meier method for cumulative incidence were performed.
A total of 17,147 newly diagnosed prostate cancer patients were found. After exclusion criteria was considered, the 2,565 remaining patients were then divided into 1,088 subjects in the injection group, 286 in the orchiectomy group, 812 in the oral group and 379 in the radical prostatectomy only group. The mean age of all the patients was 71.2 years. Multi-variant analysis showed a significantly increased risk of CVD in the injection group, orchiectomy group, oral group and radical prostatectomy group (HR = 2.94, 95% CI 2.51 to 3.45, p<0.001, HR = 3.43, 95% CI 2.69 to 4.36, p<0.001, HR = 2.87, 95% CI 2.42 to 3.39, p<0.001, HR = 1.93, 95% CI 1.5 to 2.48, p<0.001, respectively). A time dependent increased risk of CVD was also observed amongst the study groups (p<0.001).
ADT is associated with an increased risk of CVD. For long-term prostate cancer castration therapy, doctors should be aware of this complication and arrange for proper management.
雄激素剥夺疗法（ADT）是晚期前列腺癌的主要治疗方法。我们进行了一项全国性的基于人群的研究，以评估 ADT 与心血管疾病的关系。
在 2005 年至 2009 年间，从国家健康保险数据库中获取患者数据。我们将新诊断的前列腺癌患者分为四组，即促性腺激素释放激素激动剂和拮抗剂注射、口服抗雄激素、睾丸切除术和根治性前列腺切除术。还为比较目的分配了另一个匹配的非癌对照组。研究结果是新发心血管疾病（CVD）和住院治疗。进行多变量 Cox 比例风险回归分析和 Kaplan-Meier 法累积发病率。
共发现 17147 例新诊断的前列腺癌患者。在考虑排除标准后，剩余的 2565 例患者随后分为注射组 1088 例、睾丸切除术组 286 例、口服组 812 例和根治性前列腺切除术组 379 例。所有患者的平均年龄为 71.2 岁。多变量分析显示，注射组、睾丸切除术组、口服组和根治性前列腺切除术组发生 CVD 的风险显著增加（HR=2.94，95%CI2.51 至 3.45，p<0.001，HR=3.43，95%CI2.69 至 4.36，p<0.001，HR=2.87，95%CI2.42 至 3.39，p<0.001，HR=1.93，95%CI1.50 至 2.48，p<0.001）。研究组也观察到 CVD 风险随时间增加（p<0.001）。
ADT 与 CVD 风险增加相关。对于长期前列腺癌去势治疗，医生应意识到这种并发症，并进行适当的管理。
