前列腺癌雄激素剥夺治疗后的患者人口统计学特征与主要不良心血管事件

Patient Demographics and Major Adverse Cardiovascular Events after Androgen Deprivation Therapy for Prostate Cancer.

作者信息

Wallis Christopher J D, Chen Kevin C, Atkinson Stuart, Boldt-Houle Deborah M

机构信息

Division of Urology Department of Surgery University of Toronto, 60 Murray Street, Koffler Ctr, 6th Floor, Toronto, Ontario M5G3L9, Canada.

Analytics and Information Xelay Acumen Group, Inc., 181 2 Ave, Suite 488, San Mateo, California 94401, USA.

出版信息

Adv Urol. 2024 Sep 27;2024:2988289. doi: 10.1155/2024/2988289. eCollection 2024.

BACKGROUND

The association between patient demographics and CV events after ADT using real-world data was evaluated. In addition to encompassing >30 times more patients than all previous MACE studies, this is the first study, to the best of our knowledge, to include a comprehensive listing of many demographic factors from one large, recent US dataset over a long period of time.

MATERIALS AND METHODS

The retrospective analysis of data in the Decision Resources Group (now Clarivate) Real World Evidence repository, representing >300M US patients from 1991 to 2020 across all US regions, was performed. Patients with PCa receiving ≥1 ADT injection were included. MACE risk after ADT initiation was evaluated for demographic and potential PCa-related risk factors. Kaplan-Meier survival curves were constructed, and Cox regression was used to evaluate the association between MACE risk and demographic/PCa-related risk factors.

RESULTS

Overall, MACE risk was slightly lower in the first year after ADT initiation (3.9%) vs. years 2-4 (∼5.2%). In a multivariate Cox model, MACE risk after ADT initiation was significantly higher for older vs. younger patients (adjusted HR per increasing year = 1.08, 95% CI: 1.07-1.09), men with a history of MACE vs. without (HR = 2.22, 95% CI: 1.72-2.88), men with very low BMI vs. normal or high BMI (HR for decreasing BMI per kg/m = 1.02, 95% CI: 1.01-1.03), White vs. Black patients (HR = 1.30, 95% CI: 1.08-1.55), and patients who did not use statins vs. those who did (HR = 1.13, 95% CI: 1.00-1.27). Of the PCa-related risk factors, MACE risk after ADT initiation was significantly higher for oncology vs. urology treatment setting (HR = 2.47, 95% CI: 2.12-2.88), patients with baseline metastasis vs. those without (HR = 2.30, 95% CI: 1.72-3.07), and patients treated with antagonists vs. agonists (HR = 1.62, 95% CI: 1.25-2.10).

CONCLUSIONS

Demographic factors are important contributors to increased MACE risk for men with PCa on ADT. Clinicians should monitor risk factors and modify if possible.

背景

利用真实世界数据评估了患者人口统计学特征与雄激素剥夺治疗（ADT）后心血管事件之间的关联。除了纳入的患者数量比之前所有主要不良心血管事件（MACE）研究多30倍以上外，据我们所知，这是第一项长期纳入来自一个近期美国大型数据集的许多人口统计学因素综合清单的研究。

材料与方法

对决策资源集团（现为科睿唯安）真实世界证据库中的数据进行回顾性分析，该数据库代表了1991年至2020年美国所有地区的3亿多名美国患者。纳入接受≥1次ADT注射的前列腺癌患者。评估ADT开始后MACE风险与人口统计学和潜在前列腺癌相关风险因素之间的关系。构建Kaplan-Meier生存曲线，并使用Cox回归评估MACE风险与人口统计学/前列腺癌相关风险因素之间的关联。

结果

总体而言，ADT开始后的第一年MACE风险（3.9%）略低于第2 - 4年（约5.2%）。在多变量Cox模型中，ADT开始后，老年患者与年轻患者相比MACE风险显著更高（每增加一岁调整后风险比=1.08，95%置信区间：1.07 - 1.09），有MACE病史的男性与无MACE病史的男性相比（风险比=2.22，95%置信区间：1.72 - 2.88），极低体重指数（BMI）的男性与正常或高BMI的男性相比（每降低1kg/m²BMI的风险比=1.02，95%置信区间：1.01 - 1.03），白人患者与黑人患者相比（风险比=1.30，95%置信区间：1.08 - 1.55），未使用他汀类药物的患者与使用他汀类药物的患者相比（风险比=1.13，95%置信区间：1.00 - 1.27）。在前列腺癌相关风险因素中，ADT开始后，肿瘤治疗环境与泌尿外科治疗环境相比MACE风险显著更高（风险比=2.47，95%置信区间：2.12 - 2.88），有基线转移的患者与无基线转移的患者相比（风险比=2.30，95%置信区间：1.72 - 3.07），接受拮抗剂治疗的患者与接受激动剂治疗的患者相比（风险比=1.62，95%置信区间：1.25 - 2.10）。