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

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(121 856例)。比较两组的基线临...

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

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(χ²=8.10,P=0.004),and the incidence of Alzheimer's disease was also higher in the ADT group than in the control group(χ²=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's disease is increased in elderly prostate cancer patients aged 75 years and older after ADT.