75岁及以上的老年前列腺癌患者雄激素剥夺治疗后的长期认知障碍风险分析  

The risk analysis of long-term cognitive impairment after androgen deprivation therapy in elderly prostate cancer patients aged 75 years and over

作　　者：李建华[1] 王雷[1] 邱晓东[1] 朱照伟[2] Li Jianhua;Wang Lei;Qiu Xiaodong;Zhu Zhaowei(Department of Urology,the First People's Hospital of Shangqiu City,Shangqiu 476100,China;Department of Urology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]商丘市第一人民医院泌尿外科,476100 [2]郑州大学第一附属医院泌尿外科,450052

出　　处：《中华老年医学杂志》2021年第3期319-322,共4页Chinese Journal of Geriatrics

基　　金：国家自然科学基金青年科学基金项目(81702503)。

摘　　要：目的观察75岁及以上老年前列腺癌患者雄激素剥夺治疗(ADT)后的长期认知障碍风险,并分析ADT应用和认知障碍的相关性.方法回顾性队列研究,纳入1996-2003年在美国国立癌症数据库(SEER)中75岁及以上老年前列腺癌患者,根据是否行ADT分为ADT组(82514例)和对照组(121856例).比较两组的基线临床资料,随访观察认知、Kaplan-Meier生存分析和Log-rank检验比较两组的认知障碍(痴呆症和阿尔兹海默病)发生率.Cox风险比例回归分析评估ADT治疗和认知障碍的相关性.结果共纳入204370例患者,平均(79.2±4.6)岁.与对照组比较,ADT组的年龄更大,前列腺特异抗原水平更高,肿瘤分化不良比例更高,并发症更多,放疗比例更高(均为P<0.05).平均随访(12.1±3.3)年,随访中共诊断41661例痴呆症,其中ADT组13634例,对照组28027例;诊断28945例阿尔茨海默病患者,其中ADT组9372例,对照组19573例.Kaplan-Meier生存分析和Log-rank检验结果显示,ADT组的痴呆症发生率高于对照组(χ^(2)=8.10,P=0.004),阿尔茨海默病的发生率也高于对照组(χ^(2)=5.06,P=0.024).Cox回归分析结果显示,与无ADT治疗相比,ADT治疗显著增加痴呆症(HR=1.71,95%CI:1.14~2.57,P=0.01)和阿尔茨海默病的发生风险(HR=1.63,95%CI:1.08~2.46,P=0.02).结论75岁及以上老年前列腺癌患者去势治疗后,增加出现痴呆症和阿尔兹海默病的风险.Objective To examine the risk of long-term cognitive impairment in elderly prostate cancer patients aged 75 years and older undergoing androgen deprivation therapy(DAT),and to analyze the correlation between DAT and cognitive impairment.Methods This was a retrospective cohort study.Elderly prostate cancer patients aged 75 years and older in the National Cancer Database(SEER)from 1996-2003 were included.According to whether ADT was received,patients were divided into the ADT group(n=82514)and the control group(n=121856).Baseline clinical data were compared between the two groups.Kaplan-Meier survival analysis and the Log-rank test were used to compare the incidence of cognitive impairment(dementia and Alzheimer's disease)between the two groups.Cox risk ratio regression analysis was used to assess the relationship between ADT and cognitive impairment.Results A total of 204370 patients were enrolled in this study.The mean age of patients was(79.2±4.6)years.Compared with the control group,the ADT group was older and had higher prostate specific antigen levels,higher proportions of poorly differentiated tumors,more complications and a higher proportion of patients receiving radiotherapy(P<0.05).During the follow-up of(12.1±3.3)years,a total of 41661 cases of dementia were diagnosed,including 13634 in the ADT group and 28027 in the control group,and 28945 cases of Alzheimer's disease were diagnosed,including 9372 in the ADT group and 19573 in the control group.Kaplan-Meier survival analysis and the log-rank test showed that the incidence of dementia in the ADT group was higher than that in the control group(χ^(2)=8.10,P=0.004),and the incidence of Alzheimer's disease was also higher in the ADT group than in the control group(χ^(2)=5.06,P=0.024).Cox regression analysis results showed that ADT significantly increased the risk of dementia(HR=1.71,95%CI:1.14-2.57,P=0.01)and Alzheimer's disease(HR=1.63,95%CI:1.08-2.46,P=0.02),compared with treatment that did not include ADT.Conclusions The risk of dementia and Alzheimer

关 键 词：前列腺肿瘤 雄激素剥夺治疗 认知障碍 

分 类 号：R737.25[医药卫生—肿瘤]