Risk of Depression After Radical Prostatectomy-A Nationwide Registry-based Study
Risk of Depression After Radical Prostatectomy-A Nationwide Registry-based Study
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DOI：
10.1016/j.euo.2019.06.020
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发表时间：
2021-08-06
影响因子：
8.2
通讯作者：
Brasso, Klaus
中科院分区：
文献类型：
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作者：
Friberg, Anne Sofie;Dalton, Susanne Oksbjerg;Brasso, Klaus
背景：前列腺癌患者抑郁的发生取决于多种疾病和患者相关因素。目的：研究根治性前列腺切除术后抑郁的风险，重点关注手术和后续补救放疗或雄激素剥夺治疗的影响。设计、设置和参与者：一项基于人群的队列研究，纳入了1998年至2011年在丹麦接受根治性前列腺切除术的5570名男性，由丹麦前列腺癌登记处确定。结果测量和统计分析：协变量和主要结果（定义为抑郁症的医院联系人或已赎回的抗抑郁药处方）的数据来自丹麦全国登记处。采用累积发病率函数和考克斯模型，以手术后时间作为基础时间尺度，评估抑郁风险。挽救手术的暴露作为时变协变量纳入，并针对混杂因素调整分析。结果和局限性：在长达18年的随访中，与无癌症的男性相比，接受手术的男性抑郁症的累积发病率增加，特别是在雄激素剥夺治疗的男性中。与未进行后续治疗相比，接受后续雄激素剥夺治疗的患者抑郁风险增加（风险比[HR] 1.8，95%置信区间[CI] 1.4-2.3），补救放疗（HR 1.3，95% CI 1.0-1.6），以及校正年龄、手术年份、收入和同居状态后的联合治疗（HR 2.2，95% CI 1.8-2.8）。对科摩罗的进一步调整几乎没有改变估计。结论：根治性前列腺切除术和随后的挽救性手术增加了抑郁症的风险，随后接受雄激素剥夺治疗的男性主要处于风险之中。因此，临床医生应该意识到接受治疗的患者术后复发的抑郁症状。患者总结：在一项基于人群的研究中，我们发现根治性乳腺癌切除术和随后的放射或内分泌操作治疗显著增加了临床抑郁症的风险。(c)2019年欧洲泌尿外科协会。Elsevier B. V.出版，保留所有权利。
Background: Development of depression in prostate cancer patients depends on multiple disease-and patient-related factors. Objective: To investigate the risk of depression following radical prostatectomy focussing on the impact of surgery and subsequent treatment with salvage radiation or androgen deprivation therapy. Design, setting, and participants: A population-based cohort study of 5570 men who underwent radical prostatectomy in Denmark from 1998 to 2011 was identified in the Danish Prostate Cancer Registry. Outcome measurements and statistical analysis: Data on covariates and primary outcome defined as a hospital contact for depression or a redeemed antidepressant prescription were obtained from nationwide Danish registries. The risk of depression was evaluated using cumulative incidence functions and Cox models with time since surgery as an underlying time scale. Exposure to salvage procedures was included as time-varying covariates, and analyses were adjusted for confounders. Results and limitations: The cumulative incidence of depression was increased in men who had undergone surgery compared with cancer-free men throughout follow-up of up to 18 yr, particularly among men on androgen deprivation therapy. Compared with no subsequent treatment, the risk of depression was increased with subsequent androgen deprivation therapy (hazard ratio [HR] 1.8, 95% confidence interval [CI] 1.4-2.3), salvage radiation (HR 1.3, 95% CI 1.0-1.6), and the treatments combined (HR 2.2, 95% CI 1.8-2.8) after adjustments for age, year of surgery, income, and cohabitation status. Further adjustment for comorbidity hardly changed the estimates. Conclusions: Radical prostatectomy and subsequent salvage procedures increase the risk of depression, and men with subsequent androgen deprivation therapy are mainly at risk. Clinicians should thus be aware of depressive symptoms in patients receiving treatment for postsurgical relapse. Patient summary: In a population-based study, we found that radical prostatectomy and subsequent treatments with either radiation or endocrine manipulation signifi-cantly increased the risk of developing clinical depression. (c) 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.