Association of Clinical Benign Prostate Hyperplasia with Prostate Cancer Incidence and Mortality Revisited: A Nationwide Cohort Study of 3 009 258 Men
Association of Clinical Benign Prostate Hyperplasia with Prostate Cancer Incidence and Mortality Revisited: A Nationwide Cohort Study of 3 009 258 Men
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DOI：
10.1016/j.eururo.2011.06.016
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发表时间：
2011-10-01
期刊：
影响因子：
23.4
通讯作者：
Nordestgaard, Borge G.
中科院分区：
文献类型：
--
作者：
Orsted, David D.;Bojesen, Stig E.;Nordestgaard, Borge G.
背景资料：虽然良性前列腺增生（BPH）和前列腺癌（PCa）具有共同的特征，如前列腺依赖性生长和对抗雄激素治疗的反应，但BPH通常不被认为是癌前病变。目的：确定临床BPH是否与PCa发病率和死亡率增加的风险相关。设计、设置和参与者：使用来自五个国家登记处的个体参与者数据设计，我们研究了1980年至2006年的整个丹麦男性人口，共3009258名丹麦男性。我们收集了PCa诊断（n = 53 315），PCa死亡率信息（n = 25 459），并确定临床BPH（未经组织学证实的BPH）通过住院治疗（n = 187 591）和/或手术（n = 77 698）和α-肾上腺素能受体拮抗剂的使用（n = 143 365）和/或使用5 α-还原酶抑制剂（5-阿里斯）（n = 47 465），1995年至2006年。使用Kaplan-累积发生率和考克斯比例风险比（HR）的Meier图，调整了潜在混杂因素。结果和局限性：对于整个队列研究，PCa发生率的多变量校正HR为2.22（95%置信区间，2.13-2.31）和3.26（3.03-3.50）的男性手术的临床BPH与一般人群对照。相应的住院治疗和手术治疗的PCa死亡率HR分别为2.00（1.91-2.08）和7.85（7.40-8.32）。对于年龄匹配的队列研究，住院治疗的PCa发生率的相应HR为3.04（2.96-3.13），手术为2.60（2.47-2.73），α-肾上腺素能受体拮抗剂为4.49（4.33-4.65），5-ARI为2.54（2.40-2.68）。每个类别的临床前列腺增生症有局限性，但限制不同的类别，因此不太可能解释的results.Conclusions：在丹麦男性随访长达27年，临床前列腺增生症与前列腺癌发病率的风险增加了两到三倍，并与两到八倍的前列腺癌死亡率的风险增加。这些数据不应用于推断因果关系。(C)2011年欧洲泌尿外科协会。Elsevier B. V.出版，保留所有权利。
Background: Although benign prostate hyperplasia (BPH) and prostate cancer (PCa) share features such as hormone-dependent growth and response to treatment with antiandrogen therapy, BPH is generally not considered a premalignant lesion.Objective: To determine whether clinical BPH is associated with an increased risk of PCa incidence and mortality.Design, setting, and participants: Using designs with individual participant data from five national registries, we studied the entire Danish male population from 1980 through 2006, a total of 3 009 258 Danish men. We collected PCa diagnoses (n = 53 315), information on PCa mortality (n = 25 459), and ascertained clinical BPH (not histologically proven BPH) through hospitalization (n = 187 591) and/or surgery (n = 77 698) from 1980 to 2006 and the use of alpha-adrenergic receptor antagonists (n = 143 365) and/or the use of 5 alpha-reductase inhibitors (5-ARIs) (n = 47 465) from 1995 to 2006.Measurements: PCa incidence and mortality was assessed for each category of clinical BPH using Kaplan-Meier plots of cumulative incidence and Cox proportional hazard ratios (HRs) adjusted for potential confounders.Results and limitations: For the entire cohort studies, multivariate-adjusted HRs for PCa incidence were 2.22 (95% confidence interval, 2.13-2.31) in men hospitalized and 3.26 (3.03-3.50) in men operated on for clinical BPH versus general population controls. Corresponding HRs for PCa mortality were 2.00 (1.91-2.08) for hospitalization and 7.85 (7.40-8.32) for surgery. For age-matched cohort studies, corresponding HRs for PCa incidence were 3.04 (2.96-3.13) for hospitalization, 2.60 (2.47-2.73) for surgery, 4.49 (4.33-4.65) for alpha-adrenergic receptor antagonist use, and 2.54 (2.40-2.68) for 5-ARI use. Each category of clinical BPH has limitations, but limitations differ between the categories and therefore are unlikely to explain the results.Conclusions: In Danish men followed for up to 27 yr, clinical BPH was associated with a two-to three-fold increased risk of PCa incidence and with a two-to eight-fold increased risk of PCa mortality. These data should not be used to infer causality. (C) 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.