攝護腺癌病人接受雄性素剝奪治療之骨折風險: 系統性回顧與統合分析
陳柏諺、吳承誌、王弘仁
高雄長庚紀念醫院 泌尿科
高雄長庚紀念醫院 藥劑部 臨床藥學科
Fracture risk of androgen deprivation therapy among non-metastatic prostate cancer population: a systematic review and meta-analysis
Po Yen Chen, Cheng Chih Wu, Hung-Jen Wang
Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
Division of Clinical Pharmacy Service, Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
Background & Objectives
Androgen deprivation therapy (ADT) remains one of important therapeutic strategies in localized prostate cancer (PCa). Recently published meta-analysis indicated that patients with PCa and ADT have a high prevalence of osteoporosis. However, there is lack of information on fracture under ADT use. The aim of the current study is to retrieve newly published research to determine the risk between ADT and fracture.
Methods
Electronic searches were performed in PubMed and Cochrane. Key terms are (androgen deprivation therapy OR Flutamide OR Bicalutamide OR Nilutamide OR Histrelin OR Leuprolide OR Goserelin OR Triptorelin OR Abiraterone OR Enzalutamide OR gonadotropin-releasing hormone agonist OR Luteinising-hormone releasing hormone agonist OR anti-androgen OR orchiectomy) AND fracture. Articles published in English and ranging from 1975 to 2019 were retrieved. Time-to-event outcomes as hazard ratios (HRs) and adjusted dichotomous outcomes (OR and RR) with 95% CI were extracted from included research. Statistical heterogeneity was assessed using the I2 statistic.
Results
Our search yielded 548 potential reports. We extracted 20 articles after screening all titles and abstracts. We focus on the incidence of fracture as primary outcome. ADT users were discovered to have 1.16-fold increased fracture risk (HR=1.16(1.12, 1.20)) with I2=0%, while elevated risk of fracture in terms of OR has been noted with extraordinary high heterogeneity (I2=98%). Hip fracture has been found 1.55-fold increased risk. Higher dosage of ADT (including >9 doses & >11 doses) is related to elevated risk of fracture as well. Individual ADT possesses different risk. GnRH agonists, anti-androgen, and orchiectomy are associated increased risk, with 1.34-fold, 2.5-fold, and 1.9-fold risk respectively.
Conclusion
In conclusion, ADTs were identified 1.16-fold increased fracture risk. Consistent elevated risk was noted on fracture of different sites, individual ADT, accumulative dosage, and different outcome variables.