학술논문
Cardiovascular Mortality and Duration of Androgen Deprivation in Locally Advanced Prostate Cancer: Long-term Update of NRG/RTOG 9202.
Document Type
Academic Journal
Author
Mak KS; Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA. Electronic address: kimberley.mak@bmc.org.; Scannell Bryan M; University of Illinois Cancer Center, Chicago, IL, USA.; Dignam JJ; University of Chicago, Chicago, IL, USA; NRG Oncology Statistics and Data Management Center, Philadelphia, PA, USA.; Shipley WU; Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.; Lin Y; Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.; Peters CA; Northeast Radiation Oncology Center, Dunmore, PA, USA.; Gore EM; Medical College of Wisconsin and the Zablocki Veteran Affairs Medical Center, Milwaukee, WI, USA.; Rosenthal SA; Sutter Cancer Centers, Roseville, CA, USA.; Zeitzer KL; Albert Einstein Medical Center, Philadelphia, PA, USA.; D'Souza DP; London Regional Cancer Program, London, ON, Canada.; Horwitz EM; Fox Chase Cancer Center, Philadelphia, PA, USA.; Pisansky TM; Mayo Clinic, Rochester, MN, USA.; Maier JM; Wayne State University-Karmanos Cancer Institute, Detroit, MI, USA.; Chafe SM; Cross Cancer Institute, Edmonton, AB, USA.; Robin TP; University of Colorado Hospital, Aurora, CO, USA.; Roach M 3rd; University of California San Francisco, San Francisco, CA, USA.; Tran PT; University of Maryland, Baltimore, MD, USA.; Souhami L; The Research Institute of the McGill University Health Centre, Montreal, QC, Canada.; Michalski JM; Washington University School of Medicine, Saint Louis, MO, USA.; Hartford AC; Dartmouth-Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH, USA.; Feng FY; University of California San Francisco, San Francisco, CA, USA.; Sandler HM; Cedars-Sinai Medical Center, Los Angeles, CA, USA.; Efstathiou JA; Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Source
Publisher: Elsevier B.V Country of Publication: Netherlands NLM ID: 101665661 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2405-4569 (Electronic) Linking ISSN: 24054569 NLM ISO Abbreviation: Eur Urol Focus Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Androgen deprivation therapy (ADT) has been associated with coronary heart disease and myocardial infarction (MI) in prostate cancer patients, but controversy persists regarding its effects on cardiovascular mortality (CVM).
Objective: We assessed the long-term relationship between ADT and CVM in a prostate cancer randomized trial (NRG Oncology/Radiation Therapy Oncology Group 9202).
Design, Setting, and Participants: From 1992 to 1995, 1554 men with locally advanced prostate cancer (T2c-T4, prostate-specific antigen <150 ng/ml) received radiotherapy with 4 mo (short-term [STADT]) versus 28 mo (longer-term [LTADT]) of ADT.
Outcome Measurements and Statistical Analysis: Using the Fine-Gray and Cox regression models, the relationship between ADT and mortality was evaluated.
Results and Limitations: With a median follow-up of 19.6 yr, LTADT was associated with improved overall survival (OS) versus STADT (adjusted hazard ratio [HR] 0.88; p = 0.03) and prostate cancer survival (subdistribution HR [sHR] 0.70, p = 0.003). Comparing LTADT with STADT, prostate cancer mortality improved by 6.0% (15.6% [95% confidence interval 13.0-18.3%] vs 21.6% [18.6-24.7%]) at 15 yr, while CVM increased by 2.2% (14.9% [12.4-17.6%] vs 12.7% [10.4-15.3%]). In multivariable analyses, LTADT was not associated with increased CVM versus STADT (sHR 1.22 [0.93-1.59]; p = 0.15). An association between LTADT and MI death was detected (sHR 1.58 [1.00-2.50]; p = 0.05), particularly in patients with prevalent cardiovascular disease (CVD; sHR 2.54 [1.16-5.58]; p = 0.02).
Conclusions: With 19.6 yr of follow-up, LTADT was not significantly associated with increased CVM in men with locally advanced prostate cancer. Patients may have increased MI mortality with LTADT, particularly those with baseline CVD. Overall, there remained a prostate cancer mortality benefit and no OS detriment with LTADT.
Patient Summary: In a long-term analysis of a large randomized prostate cancer trial, radiation with 28 mo of hormone therapy did not increase the risk of cardiovascular death significantly versus 4 mo of hormone therapy. Future studies are needed for patients with pre-existing heart disease, who may have an increased risk of myocardial infarction death with longer hormone use.
(Copyright © 2024 European Association of Urology. Published by Elsevier B.V. All rights reserved.)
Objective: We assessed the long-term relationship between ADT and CVM in a prostate cancer randomized trial (NRG Oncology/Radiation Therapy Oncology Group 9202).
Design, Setting, and Participants: From 1992 to 1995, 1554 men with locally advanced prostate cancer (T2c-T4, prostate-specific antigen <150 ng/ml) received radiotherapy with 4 mo (short-term [STADT]) versus 28 mo (longer-term [LTADT]) of ADT.
Outcome Measurements and Statistical Analysis: Using the Fine-Gray and Cox regression models, the relationship between ADT and mortality was evaluated.
Results and Limitations: With a median follow-up of 19.6 yr, LTADT was associated with improved overall survival (OS) versus STADT (adjusted hazard ratio [HR] 0.88; p = 0.03) and prostate cancer survival (subdistribution HR [sHR] 0.70, p = 0.003). Comparing LTADT with STADT, prostate cancer mortality improved by 6.0% (15.6% [95% confidence interval 13.0-18.3%] vs 21.6% [18.6-24.7%]) at 15 yr, while CVM increased by 2.2% (14.9% [12.4-17.6%] vs 12.7% [10.4-15.3%]). In multivariable analyses, LTADT was not associated with increased CVM versus STADT (sHR 1.22 [0.93-1.59]; p = 0.15). An association between LTADT and MI death was detected (sHR 1.58 [1.00-2.50]; p = 0.05), particularly in patients with prevalent cardiovascular disease (CVD; sHR 2.54 [1.16-5.58]; p = 0.02).
Conclusions: With 19.6 yr of follow-up, LTADT was not significantly associated with increased CVM in men with locally advanced prostate cancer. Patients may have increased MI mortality with LTADT, particularly those with baseline CVD. Overall, there remained a prostate cancer mortality benefit and no OS detriment with LTADT.
Patient Summary: In a long-term analysis of a large randomized prostate cancer trial, radiation with 28 mo of hormone therapy did not increase the risk of cardiovascular death significantly versus 4 mo of hormone therapy. Future studies are needed for patients with pre-existing heart disease, who may have an increased risk of myocardial infarction death with longer hormone use.
(Copyright © 2024 European Association of Urology. Published by Elsevier B.V. All rights reserved.)