The Impact of Comorbidity and Age on Timing of Androgen Deprivation Therapy in Men with Biochemical Recurrence after Radical Prostatectomy.
The Impact of Comorbidity and Age on Timing of Androgen Deprivation Therapy in Men with Biochemical Recurrence after Radical Prostatectomy.
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合并症和年龄对根治性前列腺切除术后生化复发男性雄激素剥夺治疗时机的影响。
DOI：
10.1097/upj.0000000000000189
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发表时间：
2021
期刊：
影响因子：
0.8
通讯作者：
Daskivich,TimothyJ
中科院分区：
文献类型：
--
作者：
Moradzadeh,Ariel;Howard,LaurenE;Freedland,StephenJ;Amling,ChristopherL;Aronson,WilliamJ;Cooperberg,MatthewR;Kane,ChristopherJ;Klaassen,Zachary;Terris,MarthaK;Daskivich,TimothyJ
有主要合并症的老年男性雄激素剥夺治疗的发病率和死亡率更高，这些男性在生化复发后立即进行雄激素剥夺治疗的益处尚不清楚。我们在根治性前列腺切除术后生化复发的男性队列中评估了雄激素剥夺治疗时间随年龄和合并症的变化。方法分析VA SEARCH数据库中2000 - 2017年2097例根治性前列腺切除术后生化复发的男性患者。我们确定了生化复发时的年龄和Deyo-Charlson合并症指数评分。应用Kaplan-Meier分析和多变量logistic回归分析确定在雄激素剥夺治疗开始时年龄和Deyo-Charlson合病指数与前列腺特异性抗原的关系。结果以雄激素剥夺治疗时前列腺特异性抗原为结果的Kaplan-Meier分析显示，所有患者雄激素剥夺治疗开始时前列腺特异性抗原中位数为6.2 ng/ml (95% CI 5.1 ~ 7.1)，但在接受辅助/补救性放疗的患者（3.6 ng/ml, 95% CI 2.8 ~ 4.3）和未接受辅助/补救性放疗的患者（12.1 ng/ml, 95% CI 9.6 ~ 15.2, p <0.001）之间存在差异。在多变量Cox回归中，在雄激素剥夺治疗开始时，高龄（p=0.03）与前列腺特异性抗原升高相关，但与更严重的共病（p=0.25）无关。在所有患者中，与60 - 64岁（5.0 ng/ml, 95% CI 3.9-6.6）、65-69岁（6.6 ng/ml, 95% CI 4.9-8.8）、70-74岁（8.8 ng/ml, 95% CI 6.1-12.3）和≥75岁（14.1 ng/ml, 95% CI 5.5-37.8）患者相比，接受雄激素剥夺治疗的前列腺特异性抗原在<60岁（3.7 ng/ml, 95% CI 2.6-5.8）中较低。相比之下，前列腺特异性抗原在合并症亚组中相似（deyocharlson合并症指数0:6.3 ng/ml, 95% CI 5.0-7.9 vs deyocharlson合并症指数3或更高：5.6 ng/ml, 95% CI 4.1-7.4）。总的来说，这些关系在接受辅助/补救性放疗的亚组中是一致的。结论男性合并症患者在低前列腺特异性抗原水平下可接受雄激素剥夺治疗，且雄激素剥夺治疗的发病率和死亡率增高。
IntroductionOlder men with major comorbidities have higher risks of morbidity and mortality from androgen deprivation therapy, and the benefits of immediate androgen deprivation therapy after biochemical recurrence in these men are unclear. We assessed variation in timing of androgen deprivation therapy by age and comorbidity in a cohort of men with biochemical recurrence after radical prostatectomy.MethodsWe analyzed 2,097 men with biochemical recurrence after radical prostatectomy from 2000 to 2017 in the VA SEARCH database. We ascertained age and Deyo-Charlson comorbidity index scores at biochemical recurrence. Kaplan-Meier analysis and multivariable logistic regression were used to determine association of age and Deyo-Charlson comorbidity index with prostate specific antigen at the initiation of androgen deprivation therapy.ResultsIn Kaplan-Meier analysis with prostate specific antigen at androgen deprivation therapy as the outcome, median prostate specific antigen at androgen deprivation therapy initiation was 6.2 ng/ml (95% CI 5.1−7.1) across all patients but differed among those who received adjuvant/salvage radiation (3.6 ng/ml, 95% CI 2.8−4.3) and those who did not (12.1 ng/ml, 95% CI 9.6−15.2, p <0.001). In multivariable Cox regression, advanced age (p=0.03) but not worse comorbidity (p=0.25) was associated higher prostate specific antigen at initiation of androgen deprivation therapy. Across all patients, prostate specific antigen at androgen deprivation therapy was lower among those <60 years old (3.7 ng/ml, 95% CI 2.6–5.8) compared to those 60–64 (5.0 ng/ml, 95% CI 3.9–6.6), 65–69 (6.6 ng/ml, 95% CI 4.9–8.8), 70–74 (8.8 ng/ml, 95% CI 6.1–12.3) and ≥75 years old (14.1 ng/ml, 95% CI 5.5–37.8). In contrast, prostate specific antigen at androgen deprivation therapy was similar among comorbidity subgroups (Deyo-Charlson comorbidity index 0: 6.3 ng/ml, 95% CI 5.0–7.9 vs Deyo-Charlson comorbidity index 3 or higher: 5.6 ng/ml, 95% CI 4.1–7.4). In general, these relationships were consistent among subgroups receiving adjuvant/salvage radiation.ConclusionsMen with comorbid disease at increased risk of morbidity and mortality with androgen deprivation therapy often receive androgen deprivation therapy at low prostate specific antigen values.
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DOI：
10.1016/s0022-5347(05)00388-5
发表时间：
2005-07
期刊：
JAMA
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DOI：
10.1093/jnci/djp404
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2010-01-06
期刊：
JOURNAL OF THE NATIONAL CANCER INSTITUTE
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