【摘要】 目的回顾性分析美国国立癌症数据库(SEER)老年前列腺癌患者雄激素去势治疗(ADT)后的长期心力衰竭(HF)风险,并分析ADT和HF风险的相关性。方法回顾性观察性研究。纳入1996—2003年在SEER数据库中老年(≥65岁)前列腺癌患者,根据是否给予ADT治疗分为ADT组(82 514例)和对照组(121 856例)。比较两组的基线临床资料,Kaplan-Meier生存分析和Log-rank检验比较两组的长期随访的HF发生率。Cox风险比例回归分析评估ADT治疗和HF的相关性。结果共纳入204 370例患者,平均年龄为(77.2±11.8)岁。与对照组比较,ADT组的年龄更大,合并糖尿病、高血压的比例更高,前列腺特异抗原水平更高,肿瘤分化不良比例更高,社会经济状况更差(均为P<0.05)。平均随访(13.1±2.7)年,共诊断48 496例HF,其中ADT组23 893例,对照组26 603例。Kaplan-Meier生存分析和Log-rank检验结果显示,ADT组和对照组随访5年HF发生率分别为6.4%和2.8%,随访10年HF发生率分别为15.7%和8.1%,随访15年的HF发生率分别为21.7%和14.9%,ADT组的HF发生率显著高于非ADT组(24.9%比16.2%,HR=1.582,95%CI:1.217～2.074,P=0.001)。采用多因素Cox比例风险回归模型,结果显示ADT治疗是HF的独立危险因素(HR=2.261,95%CI:1.519～3.365,P=0.002)。另外,高血压(HR=2.802,95%CI:1.674～4.690,P=0.001)、糖尿病(HR=3.158,95%CI:2.127～4.519,P=0.001)、高龄(≥75岁)(HR=5.662,95%CI:2.583～12.411,P=0.001)和社会经济状况低(HR=4.293,95%CI:1.834～8.830,P=0.003)均为HF的危险因素。结论老年前列腺癌患者ADT治疗后出现HF的风险明显增高,ADT是增加发生HF风险的独立危险因素之一。更多还原

【Abstract】 Objective To retrospectively analyze the risk of long-term heart failure( HF) after androgen deprivation therapy( ADT) for elderly prostate cancer patients in the US National Cancer Database( SEER),and analyze the correlation between ADT and HF risk. Methods This was a retrospective observational study. Elderly( ≥65 years) prostate cancer patients in the SEER database from 1996 to 2003 were included,and were divided into ADT group( 82 514 cases) and control group( 121 856 cases)according to whether or not they underwent ADT. The baseline clinical data of the two groups were compared. Kaplan-Meier survival analysis and log-rank test was used to compare the incidence of HF during long-term follow-up. Cox risk ratio regression analysis was used to evaluate the correlation between ADT and HF. Results A total of 204 370 elderly patients were enrolled,with an average age of( 77. 2 ± 11. 8)years. Compared with the control group,the ADT group was older,had a higher proportion of diabetes and hypertension,a higher level of prostate specific antigen,poor tumor differentiation,and worse socioeconomic status( all P<0. 05). The average follow-up was( 13. 1±2. 7) years. During the follow-up,48 496 cases of HF were diagnosed,including 23 893 cases in the ADT group and 26 603 cases in the control group.Kaplan-Meier survival analysis and log-rank test showed that the annual incidence of HF were 6. 4% and2. 8%,15. 7% and 8. 1%,21. 7% and 14. 9% at 5-,10-and 15-year of follow-up,respectively. The incidence of HF was significantly higher in the ADT group than that in the control group( 24. 9% vs.16. 2%,HR = 1. 582,95%CI: 1. 217-2. 074,P = 0. 001). Multivariate Cox proportional hazard regression model showed that ADT was an independent risk factor for HF( HR = 2. 261,95% CI: 1. 519-3. 365,P =0. 002). In addition,hypertension( HR = 2. 802,95% CI: 1. 674-4. 690,P = 0. 001),diabetes( HR =3. 158,95%CI: 2. 127-4. 519,P = 0. 001),advanced age( ≥75 years)( HR = 5. 662,95% CI: 2. 583-12. 411,P = 0. 001) and low socioeconomic status( HR = 5. 662,95%CI: 2. 583-12. 411,P = 0. 001) were independent risk factors for HF. Conclusions Elderly prostate cancer patients have a significantly higher risk of HF after ADT,which is a independent risk factor for HF.更多还原