前列腺癌雄激素剥夺治疗与神经认知障碍：一项系统评价与荟萃分析
Androgen deprivation therapy for prostate cancer and neurocognitive disorders: a systematic review and meta-analysis.
作者信息
Hinojosa-Gonzalez David E, Zafar Affan, Saffati Gal, Kronstedt Shane, Zlatev Dimitar V, Khera Mohit
机构信息
Department of Urology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB 1102, Boston, MA, 02114, USA.
Scott Department of Urology, Baylor College of Medicine, 7200 Cambridge Street, Houston, TX, 77030, USA.
出版信息
Prostate Cancer Prostatic Dis. 2024 Sep;27(3):507-519. doi: 10.1038/s41391-023-00785-w. Epub 2024 Jan 2.
BACKGROUND
Prostate cancer is a prevalent disease that urgently needs to address its treatment-related complications. By examining existing evidence on the association between Androgen Deprivation Therapy (ADT) and dementia, this study contributes to the understanding of potential risks. We sought to analyze the currently available evidence regarding the risk of dementia, Alzheimer's disease (AD), vascular dementia, and Parkinson's disease (PD) in patients undergoing ADT.
METHODS
A systematic search of PubMed, EMBASE, Scopus, and Google Scholar was performed to identify studies published from the databases' inception to April 2023. Studies were identified through systematic review to facilitate comparisons between studies with and without some degree of controls for biases affecting distinctions between ADT receivers and non-ADT receivers. This review identified 305 studies, with 28 meeting the inclusion criteria. Heterogeneity was assessed using Higgins I2%. Variables with an I2 over 50% were considered heterogeneous and analyzed using a Random-Effects model. Otherwise, a Fixed-Effects model was employed.
RESULTS
A total of 28 studies were included for analysis. Out of these, only 1 study did not report the number of patients. From the remaining 27 studies, there were a total of 2,543,483 patients, including 900,994 with prostate cancer who received ADT, 1,262,905 with prostate cancer who did not receive ADT, and 334,682 patients without prostate cancer who did not receive ADT. This analysis revealed significantly increased Hazard Ratios (HR) of 1.20 [1.11, 1.29], p < 0.00001 for dementia, HR 1.26 [1.10, 1.43], p = 0.0007 for Alzheimer's Disease, HR 1.66 [1.40, 1.97], p < 0.00001 for depression, and HR 1.57 [1.31, 1.88], p < 0.00001 for Parkinson's Disease. The risk of vascular dementia was HR 1.30 [0.97, 1.73], p < 0.00001.
CONCLUSION
Based on the analysis of the currently available evidence, it suggests that ADT significantly increases the risk of dementia, AD, PD, and depression.
背景
前列腺癌是一种普遍存在的疾病，迫切需要解决其与治疗相关的并发症。通过研究雄激素剥夺疗法（ADT）与痴呆症之间关联的现有证据，本研究有助于了解潜在风险。我们试图分析目前关于接受ADT治疗的患者患痴呆症、阿尔茨海默病（AD）、血管性痴呆和帕金森病（PD）风险的现有证据。
方法
对PubMed、EMBASE、Scopus和谷歌学术进行系统检索，以识别从数据库建立到2023年4月发表的研究。通过系统评价来识别研究，以便在对影响ADT接受者和非ADT接受者区分的偏倚进行一定程度控制的研究与未进行控制的研究之间进行比较。本综述共识别出305项研究，其中28项符合纳入标准。使用希金斯I²%评估异质性。I²超过50%的变量被认为是异质性的，并使用随机效应模型进行分析。否则，采用固定效应模型。
结果
总共纳入28项研究进行分析。其中，只有1项研究未报告患者数量。在其余27项研究中，共有2,543,483名患者，包括900,994名接受ADT治疗的前列腺癌患者、1,262,905名未接受ADT治疗的前列腺癌患者以及334,682名未接受ADT治疗的非前列腺癌患者。该分析显示，痴呆症的风险比（HR）显著增加至1.20[1.11, 1.29]，p < 0.00001；阿尔茨海默病的HR为1.26[1.10, 1.43]，p = 0.0007；抑郁症的HR为1.66[1.40, 1.97]，p < 0.00001；帕金森病的HR为1.57[1.31, 1.88]，p < 0.00001。血管性痴呆的风险HR为1.30[0.97, 1.73]，p < 0.00001。
结论
基于对现有证据的分析，表明ADT显著增加了患痴呆症、AD、PD和抑郁症的风险。
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