Zhanghuang Chenghao, Wang Huake, Wang Jinkui, Li Li, Li Jinrong, Hao Zipeng, Zhang Jiacheng, Liu Ling, Yan Bing
Department of Urology, Kunming Children's Hospital (Children's Hospital affiliated to Kunming Medical University), Kunming, PR China.
Yunnan Province Clinical Research Center for Children's Health and Disease, Kunming, PR China.
PLoS One. 2025 Apr 11;20(4):e0318429. doi: 10.1371/journal.pone.0318429. eCollection 2025.
Prostate cancer (PC) is the most common malignant tumour in men, and atherosclerotic cardiovascular disease (ASCVD) is the leading cause of non-cancer death in PC patients. The main purpose of this study was to investigate whether chemotherapy increases heart-specific mortality (HSM) in elderly patients with PC.
Patient information was downloaded from the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2018. We included all elderly patients with PC. The multivariate logistic regression model was used to explore the influencing factors of patients receiving chemotherapy. Confounders were excluded using a 1:1 proportional propensity score match, and a competing risk model and cumulative incidence plot were used to analyze HSM and other cause mortality (OCM) in patients who received chemotherapy versus those who did not.
A total of 135183 elderly prostate patients were enrolled in this study, of whom 1361 received chemotherapy. The multivariate logistic regression model showed that older patients were more likely to not receive chemotherapy, married patients were more likely to receive chemotherapy, and the higher the TNM stage and tumor histological grade, the more patients received chemotherapy. In the original cohort before unmatched, there was no significant difference in HSM between chemotherapy and non-chemotherapy patients (P = 0.27). After 1:1 matching, HSM was significantly higher in patients without chemotherapy than in patients with chemotherapy (HR 2.54; P =0.002).
Our results indicate that HSM is significantly higher in patients without chemotherapy than in those with chemotherapy. Therefore, although chemotherapy can lead to cardiotoxicity in elderly patients with PC, chemotherapy does not increase the HSM of patients and will benefit patients in the long-term survival.
前列腺癌（PC）是男性最常见的恶性肿瘤，动脉粥样硬化性心血管疾病（ASCVD）是PC患者非癌症死亡的主要原因。本研究的主要目的是调查化疗是否会增加老年PC患者的心脏特异性死亡率（HSM）。
从2010年至2018年的监测、流行病学和最终结果（SEER）数据库中下载患者信息。我们纳入了所有老年PC患者。采用多因素逻辑回归模型探讨患者接受化疗的影响因素。使用1:1比例倾向评分匹配排除混杂因素，并使用竞争风险模型和累积发病率图分析接受化疗与未接受化疗患者的HSM和其他原因死亡率（OCM）。
本研究共纳入135183例老年前列腺患者，其中1361例接受了化疗。多因素逻辑回归模型显示，年龄较大的患者更不太可能接受化疗，已婚患者更可能接受化疗，TNM分期和肿瘤组织学分级越高，接受化疗的患者越多。在未匹配的原始队列中，化疗患者与未化疗患者的HSM无显著差异（P = 0.27）。1:1匹配后，未接受化疗患者的HSM显著高于接受化疗患者（HR 2.54；P = 0.002）。
我们的结果表明，未接受化疗患者的HSM显著高于接受化疗患者。因此，虽然化疗会导致老年PC患者发生心脏毒性，但化疗不会增加患者的HSM，且从长期生存来看对患者有益。
