Cardiovascular Mortality and Duration of Androgen Deprivation for Locally Advanced Prostate Cancer: Analysis of RTOG 92-02
Cardiovascular Mortality and Duration of Androgen Deprivation for Locally Advanced Prostate Cancer: Analysis of RTOG 92-02
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DOI：
10.1016/j.eururo.2008.01.021
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发表时间：
2008-10-01
期刊：
影响因子：
23.4
通讯作者：
Smith, Matthew R.
中科院分区：
文献类型：
--
作者：
Efstathiou, Jason A.;Bae, Kyounghwa;Smith, Matthew R.
目的：促性腺激素释放激素激动剂（GnRHa）与前列腺癌男性冠心病和心肌梗死的风险增加有关，但对其对心血管死亡率的潜在影响知之甚少。我们在一项大型随机试验中评估了GnRHa治疗持续时间与心血管死亡率之间的关系，该试验对接受短期与长期戈舍瑞林辅助治疗和放射治疗（RT）治疗局部晚期前列腺癌的男性进行了研究。从1992年到1995年，1554例局部晚期前列腺癌患者（T2c-4，前列腺特异性抗原[PSA] < 150 ng/ml）接受RT和戈舍瑞林4个月，然后随机分配至无额外治疗组（第1组）或24个月戈舍瑞林辅助治疗组（第2组（放射治疗肿瘤组[RTOG] 92-02）。进行了考克斯回归分析，以评价治疗组与心血管死亡率之间的关系。协变量包括年龄，流行的心血管疾病（CVD），高血压，糖尿病（DM），种族，PSA，Gleason评分，和stages.Results：后中位随访8.1年，185心血管相关的死亡发生。接受更长时间戈舍瑞林治疗的男性心血管死亡率没有增加。5年时，接受长期辅助戈舍瑞林的男性心血管死亡率为5.9%，而接受短期戈舍瑞林的男性为4.8%（Gray's p = 0.16）。在多变量分析中，治疗组与心血管死亡风险增加无显著相关性（校正的风险比[HR] = 1.09; 95%置信区间[CI]，0.81-1.47; p = 0.58;当在戈舍瑞林补救治疗时删失时，HR = 1.02，95%CI，0.73-1.43; p = 0.9）。传统的心脏病危险因素，包括年龄，流行的心血管疾病，糖尿病，显着相关的心血管mortals.Conclusions：辅助GnRHa治疗的持续时间较长，并没有出现增加心血管死亡率在男性局部晚期前列腺癌。(C)2008年欧洲泌尿外科协会。Elsevier B. V.出版，保留所有权利。
Objectives: Gonadotropin-releasing hormone agonists (GnRHa) are associated with greater risk of coronary heart disease and myocardial infarction in men with prostate cancer, but little is known about their potential effects on cardiovascular mortality. We assessed the relationship between duration of GnRHa therapy and cardiovascular mortality in a large randomized trial of men treated with short-term versus longer-term adjuvant goserelin and radiation therapy (RT) for locally advanced prostate cancer.Methods: From 1992 to 1995, 1554 men with locally advanced prostate cancer (T2c-4, prostate-specific antigen [PSA] < 150 ng/ml) received RT and 4mo of goserelin and then were randomized to no additional therapy (arm 1) or 24 mo adjuvant goserelin (arm 2) in a phase 3 trial (Radiation Therapy Oncology Group [RTOG] 92-02). Cox regression analyses were performed to evaluate the relationship between treatment arm and cardiovascular mortality. Covariates included age, prevalent cardiovascular disease (CVD), hypertension, diabetes (DM), race, PSA, Gleason score, and stage.Results: After median follow-up of 8.1 yr, 185 cardiovascular-related deaths had occurred. No increase in cardiovascular mortality occurred for men receiving a longer duration of goserelin. At 5 yr, cardiovascular mortality for men receiving longer-term adjuvant goserelin was 5.9% versus 4.8% with short-term goserelin (Gray's p = 0.16). In multivariate analyses, treatment arm was not significantly associated with increased risk of cardiovascular mortality (adjusted hazard ratio [HR] = 1.09; 95% confidence interval [CI], 0.81-1.47; p = 0.58; when censoring at time of salvage goserelin, HR = 1.02, 95%CI, 0.73-1.43; p = 0.9). Traditional cardiac risk factors, including age, prevalent CVD, and DM, were significantly associated with greater cardiovascular mortality.Conclusions: Longer duration of adjuvant GnRHa therapy does not appear to increase cardiovascular mortality in men with locally advanced prostate cancer. (C) 2008 European Association of Urology. Published by Elsevier B.V. All rights reserved.