Are higher follicle-stimulating hormone levels before androgen deprivation therapy for prostate cancer associated with oncological and cardiac outcomes and overall survival?-a population-level analysis.
Are higher follicle-stimulating hormone levels before androgen deprivation therapy for prostate cancer associated with oncological and cardiac outcomes and overall survival?-a population-level analysis.
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DOI：
10.21037/tau-23-114
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发表时间：
2023-10-31
影响因子：
2
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中科院分区：
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雄激素剥夺疗法 (ADT) 通常通过黄体生成素释放激素 (LHRH) 激动剂进行，是晚期前列腺癌 (PC) 的标准治疗方法。虽然相当有效，但它与主要不良心血管事件 (MACE) 的风险增加有关。确切的机制尚不清楚。然而，有理论认为，促卵泡激素 (FSH) 可能是罪魁祸首，FSH 是一种垂体激素，参与控制正常睾酮水平，而 LHRH 激动剂治疗会降低睾酮水平。我们进行了一项回顾性人群水平研究，以测试 FSH 水平与开始 ADT 的男性发生 MACE、去势抵抗性 PC (CRPC) 和死亡之间的联系。 1999 年至 2018 年期间开始 ADT 前 2 年内具有 FSH 水平的所有男性 (n=1,539) 均在退伍军人事务部 (VA) 卫生系统内确定了完整数据。使用既定的切点，FSH 可分为低/正常 (≤8 IU/mL) 和高 (>8 IU/mL)。使用对数秩检验和多变量 Cox 比例风险模型测试 FSH 与 MACE、死亡和 CRPC 时间之间的关联。与低/正常 FSH 患者相比，高 FSH 患者年龄较大（中位 76 岁 vs. 73 岁，P<0.001），开始 ADT 较早（中位 2007 年 vs. 2009 年，P=0.027），并且体重指数 (BMI) 较低（中位 29.1 vs. 30.1 kg/m2，P=0.004）。多变量分析显示，FSH 与 ADT 到 MACE、CRPC 或死亡的时间之间没有关联。在这项针对在开始 ADT 之前接受 FSH 测试的男性的人群水平研究中，FSH 水平与从 ADT 到 MACE、CRPC 或死亡的时间之间没有关联。尽管还需要进一步研究，但这些结果并不支持 ADT 前 FSH 与长期肿瘤或心血管结局之间的联系。
Androgen deprivation therapy (ADT), commonly delivered via a luteinizing hormone-releasing hormone (LHRH) agonist, is the standard treatment for advanced prostate cancer (PC). While quite effective, it has been associated with an increased risk of major adverse cardiovascular events (MACE). The exact mechanisms are not clear. However, it has been theorized that follicle-stimulating hormone (FSH), a pituitary hormone that is involved in controlling normal testosterone levels, which is decreased with LHRH-agonist therapy, may be the culprit. We performed a retrospective population-level study to test the link of FSH levels on the development of MACE, castrate-resistant PC (CRPC), and death among men starting ADT. All men (n=1,539) who had an FSH level between 1999 and 2018 within 2 years prior to starting ADT and complete data were identified within the Veterans Affairs (VA) Health System. FSH was dichotomized as low/normal (≤8 IU/mL) and high (>8 IU/mL), using established cut-points. The associations between FSH and time to MACE, death, and CRPC were tested using log-rank tests and multivariable Cox proportional hazards models. Patients with high FSH were older (median 76 vs. 73 years, P<0.001), started ADT earlier (median 2007 vs. 2009, P=0.027), and had lower body mass index (BMI) (median 29.1 vs. 30.1 kg/m2, P=0.004) compared to those with low/normal FSH. On multivariable analysis, there was no association between FSH and time from ADT to MACE, CRPC, or death. In this population-level study of men receiving an FSH test prior to starting ADT, there was no association between FSH levels and time from ADT to MACE, CRPC, or death. Although further studies are needed, these results do not support a link between pre-ADT FSH and long-term oncological or cardiovascular outcomes.
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影响因子：
2.9
作者：
Kourbanhoussen K;Joncas FH;D Wallis CJ;Hovington H;Dagenais F;Fradet Y;Guillemette C;Lacombe L;Toren P
通讯作者：
Toren P
影响因子：
2.8
作者：
GARDE, SV;SHETH, AR;KULKARNI, SA
通讯作者：
KULKARNI, SA
影响因子：
1.6
作者：
Porcaro, Antonio B;Siracusano, Salvatore;Artibani, Walter
通讯作者：
Artibani, Walter
影响因子：
4.8
作者：
Crawford ED;Heidenreich A;Lawrentschuk N;Tombal B;Pompeo ACL;Mendoza-Valdes A;Miller K;Debruyne FMJ;Klotz L
通讯作者：
Klotz L
影响因子：
--
作者：
Stenman, UH;Abrahamsson, PA;Ekman, P
通讯作者：
Ekman, P