心血管風險增加於雄激素阻斷治療後之新診斷的前列腺癌患者

謝享宸、李建儀、裘坤元

台中榮民總醫院 外科部 泌尿外科

Increased cardiovascular risk after androgen deprivation therapies among newly diagnosed prostate cancer patients

Hsiang-Chen Hsieh, Jian-Ri Li, Kun-Yuan Chiu

Taichung Veterans General Hospital, Division of Urology, Department of Surgery, Taichung.

Purpose: To investigate and compare the risk of cardiovascular disease (CVD) associated with different androgen deprivation therapies (ADT) and radical prostatectomy in newly diagnosed prostate cancer patients.

Materials and Methods: We retrospectively reviewed patients who had been newly diagnosed (ICD9-CM code 185) with prostate cancer and receiving androgen deprivation therapies in National Health Insurance Research Database (NHIRD) from 2005 to 2009. There were comparisons of clinical characteristics with chi-squared test and adjusted hazard ratio in survival risk between groups in different ADT.

Results: 2565 patients with newly diagnosed prostate cancer were included in the analysis with control group. 1088 patients were treated with injected hormone treatment, 286 with orchiedectomy, 812 with oral hormone treatment and 379 with radical prostatectomy. The exclusion criteria were patient under 18 year-old or age unknown, patients with diagnosis of CVD before prostate cancer and patients without treatment or with multiple combined ADTs. Diabetes, hyperlipidemia, CVD and Charlson comorbidity index (CCI) were significantly worsen (p<0.001) compared with control group in clinical characteristics. The risk of CVD associated with prostate cancer compared with control group was significant higher in all treatment group, injected hormone treatment with hazard ratio (HR) = 2.94 (95% Confidence Interval [CI] 2.51-3.45, p<0.001), orchiedectomy with HR = 3.43 (95% Confidence Interval [CI] 2.69-4.36, p<0.001), oral hormone treatment with HR = 2.87 (95% Confidence Interval [CI] 2.42-3.39, p<0.001) and radical prostatectomy with HR = 1.93 (95% Confidence Interval [CI] 1.5-2.48, p<0.001). When compared with group in radical prostatectomy, other treatment group still had higher risk in CVD associated with prostate cancer, injected hormone treatment with HR = 1.53 (95% Confidence Interval [CI] 1.19-1.96, p<0.001), orchiedectomy with HR = 1.78 (95% Confidence Interval [CI] 1.3-2.43, p<0.001) and oral hormone treatment with HR = 1.49 (95% Confidence Interval [CI] 1.15-1.93, p<0.001).

Conclusions: In our study, patients with newly diagnosed prostate cancer under ADT treatment or radical prostatectomy had higher risk of CVD compared with control group. However, patients treated with ADTs had higher risk of CVD compared with radical prostatectomy group.