Risk of Cardiovascular Ischemic Events After Surgical Castration and Gonadotropin-Releasing Hormone Agonist Therapy for Prostate Cancer: A Nationwide Cohort Study
Risk of Cardiovascular Ischemic Events After Surgical Castration and Gonadotropin-Releasing Hormone Agonist Therapy for Prostate Cancer: A Nationwide Cohort Study
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DOI：
10.1200/jco.2016.71.4204
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发表时间：
2017-11-10
影响因子：
45.3
通讯作者：
Huang, Wen-Kuan
中科院分区：
文献类型：
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作者：
Chen, Dong-Yi;See, Lai-Chu;Huang, Wen-Kuan
目的我们的目的是确定前列腺癌（PCa）患者的心血管（CV）风险在接受雄激素剥夺治疗的患者和接受促性腺激素释放激素激动剂（GnRHa）治疗的患者之间是否存在差异。患者和方法通过使用台湾国民健康保险研究数据库，我们分析了1997年1月1日以来确诊的14，715例PCa患者的数据，到2011年12月31日。患者接受双侧睾丸切除术或GnRHa治疗。我们使用治疗加权的逆概率和倾向评分来调整这两组之间协变量基线值的不平衡。考克斯回归模型被用来确定心肌梗死（MI），缺血性中风（IS），和心脏相关的complications.ResultsOverall的危险因素，3,578例PCa（24.3%）进行了双侧睾丸切除术和11,137例（75.7%）接受GnRHa治疗。在3.3年的中位随访时间内，两组的CV缺血事件风险相似（即MI或IS;风险比，1.16; 95% CI，0.97 - 1.38）。然而，在前1.5年随访期间，睾丸切除术组的CV缺血事件高于GnRHa组（风险比，1.40; 95%CI，1.04 - 1.88），尤其是在年龄≥ 65岁、患有高血压、Charlson合并症指数评分≥ 3、既往有MI、IS、结论与双侧睾丸切除术相比，GnRHa的应用不会增加PCa患者CV缺血事件的风险。尽管如此，睾丸切除术与老年患者和开始雄激素剥夺治疗后1.5年内有CV合并症病史的患者的CV缺血事件发生率较高相关。这些发现可以帮助临床医生为个别患者决定最佳的去势策略。(C)2017年美国临床肿瘤学会
PurposeOur aim was to determine whether cardiovascular (CV) risk in patients with prostate cancer (PCa) differs between those who receive androgen-deprivation therapy by surgical castration and those who receive gonadotropin-releasing hormone agonist (GnRHa) therapy.Patients and Methods By using the Taiwan National Health Insurance Research Database, we analyzed data from 14,715 patients with PCa diagnosed from January 1, 1997, through December 31, 2011. The patients were treated with bilateral orchiectomy or GnRHa therapy. We used inverse probability of treatment weighting with propensity scores to adjust for the imbalance in covariate baseline values between these two groups. Cox regression models were used to identify risk factors for myocardial infarction (MI), ischemic stroke (IS), and cardiac-related complications.ResultsOverall, 3,578 patients with PCa (24.3%) underwent bilateral orchiectomy and 11,137 patients (75.7%) received GnRHa therapy. Both groups had a similar risk of CV ischemic events (ie, MI or IS; hazard ratio, 1.16; 95% CI, 0.97 to 1.38) during a median follow-up time of 3.3 years. However, during the first 1.5 years of follow-up, there were higher CV ischemic events in the orchiectomy group than in the GnRHa group (hazard ratio, 1.40; 95% CI, 1.04 to 1.88), particularly in patients who were >= 65 years of age, had hypertension, had a Charlson comorbidity index score >= 3, and had a previous history of MI, IS, or coronary heart disease.ConclusionCompared with bilateral orchiectomy, use of GnRHa does not increase the risk of CV ischemic events in patients with PCa. Nonetheless, orchiectomy is associated with higher rates of CV ischemic events in older patients and those with a history of CV comorbidities within 1.5 years of initiating androgen-deprivation therapy. These findings can help clinicians decide on the optimal castration strategy for individual patients. (C) 2017 by American Society of Clinical Oncology