The effect of therapeutic anticoagulation on overall survival in men receiving first-line docetaxel chemotherapy for metastatic castration-resistant prostate cancer.
The effect of therapeutic anticoagulation on overall survival in men receiving first-line docetaxel chemotherapy for metastatic castration-resistant prostate cancer.
复制标题
DOI：
10.1016/j.clgc.2014.04.008
复制
发表时间：
2015-02
影响因子：
3.2
通讯作者：
Antonarakis ES
中科院分区：
文献类型：
--
作者：
Park JC;Pratz CF;Tesfaye A;Brodsky RA;Antonarakis ES
我们研究了治疗性抗凝治疗对接受一线多西紫杉醇化疗的转移性去势抵抗性前列腺癌 (mCRPC) 男性总体生存的影响。抗凝剂的使用（低分子量肝素 [LMWH] 或华法林）是从大型单一机构数据库中回顾性确定的；所有接受抗凝治疗的患者都有抗凝治疗的临床指征（即深静脉血栓形成或肺栓塞，或两者兼而有之）。我们的研究发现，抗凝药物的使用是接受多西紫杉醇治疗的 mCRPC 男性患者生存改善的独立预测因素。抗凝剂被认为具有抗肿瘤活性，尽管支持这一说法的临床数据是相互矛盾的。目前尚无关于抗凝治疗对前列腺癌患者临床影响的明确数据。本研究的目的是调查接受多西紫杉醇化疗的转移性去势抵抗性前列腺癌 (mCRPC) 患者中治疗性抗凝药物的使用与生存之间的关系。我们回顾性审查了 1998 年至 2010 年间在同一机构接受一线多西他赛化疗的 247 名连续 mCRPC 患者的记录。其中，29名患者（11.7%）接受治疗性抗凝治疗（低分子肝素[LMWH]或华法林）治疗静脉血栓栓塞。使用单变量和多变量 Cox 比例风险回归模型来研究抗凝剂使用对总体生存的影响。在单变量分析中，抗凝药物的使用与生存率的提高相关（风险比 [HR]，0.61；P = .024）。抗凝组的中位生存期为 20.9 个月，而对照组为 17.1 个月 (P = .024)。在多变量分析中，调整其他基线预后因素后，抗凝药物的使用仍然是生存的重要预测因素（HR，0.49；P = .023）。当在多变量模型中单独考虑每种抗凝剂时，LMWH 对生存仍具有显着的预后作用（HR，0.48；P = 0.035），而使用华法林则不然。抗凝剂的使用（尤其是低分子肝素）是接受多西紫杉醇治疗的 mCRPC 男性患者生存改善的独立预测因子。这些数据为进一步探索抗凝剂在前列腺癌患者中的抗肿瘤特性提供了动力，并需要在前瞻性研究中进行验证。
We examined the effect of therapeutic anticoagulation on overall survival in men with metastatic castration-resistant prostate cancer (mCRPC) receiving first-line docetaxel chemotherapy. Anticoagulant use (low-molecular-weight heparin [LMWH] or warfarin) was retrospectively ascertained from a large single-institution database; all patients who were prescribed anticoagulants had a clinical indication for anticoagulation (ie, deep vein thrombosis or pulmonary embolism, or both). Our study found that anticoagulant use was an independent predictor of improved survival in men with mCRPC receiving docetaxel. Anticoagulants have been postulated to possess antitumor activity, although clinical data supporting this claim are conflicting. No definitive data exist on the clinical impact of anticoagulation therapy in patients with prostate cancer. The aim of this study was to investigate the association between therapeutic anticoagulant use and survival in men with metastatic castration-resistant prostate cancer (mCRPC) receiving docetaxel chemotherapy. We retrospectively reviewed the records of 247 consecutive patients with mCRPC who received first-line docetaxel chemotherapy between 1998 and 2010 at a single institution. Among them, 29 patients (11.7 %) received therapeutic anticoagulation (low-molecular-weight heparin [LMWH] or warfarin) for the treatment of venous thromboembolism. Univariate and multivariable Cox proportional hazards regression models were used to investigate the effect of anticoagulant use on overall survival. In univariate analysis, anticoagulant use was associated with improved survival (hazard ratio [HR], 0.61; P = .024). Median survival was 20.9 months in the anticoagulation group versus 17.1 months in the control group (P = .024). In multivariable analysis, anticoagulant use remained a significant predictor of survival after adjusting for other baseline prognostic factors (HR, 0.49; P = .023). When each anticoagulant was considered separately in the multivariable model, LMWH remained significantly prognostic for survival (HR, 0.48; P = .035), whereas warfarin use did not. Anticoagulant use (LMWH in particular) is an independent predictor of improved survival in men with mCRPC receiving docetaxel. These data provide the impetus to further explore the antitumor properties of anticoagulants in patients with prostate cancer and warrant validation in prospective studies.
登录
查看更多内容
影响因子：
10.4
作者：
Altinbas, M;Coskun, HS;Soyuer, S
通讯作者：
Soyuer, S
影响因子：
8
作者：
Martin, CB;Mahon, GM;Whitehead, IP
通讯作者：
Whitehead, IP
影响因子：
39.2
作者：
Gould, MK;Dembitzer, AD;Garber, AM
通讯作者：
Garber, AM
影响因子：
45.3
作者：
Maurer, LH;Herndon, JE;Green, MR
通讯作者：
Green, MR
影响因子：
1.6
作者：
Lersch, C;Gericke, D;Classen, M
通讯作者：
Classen, M