Secondary Cancer after Androgen Deprivation Therapy in Prostate Cancer: A Nationwide Study.

IF 4 3区医学 Q1 ANDROLOGY World Journal of Mens Health Pub Date : 2025-01-01 Epub Date: 2024-03-14 DOI:10.5534/wjmh.230237

Jae Heon Kim, Gi Hwan Bae, Jaehun Jung, Tae Il Noh

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Abstract

Purpose: Androgen signaling is associated with various secondary cancer, which could be promising for potential treatment using androgen deprivation therapy (ADT). This study investigated whether ADT use was associated with secondary cancers other than prostate cancer in a nationwide population-based cohort.

Materials and methods: A total, 278,434 men with newly diagnosed prostate cancer between January 1, 2002 and December 31, 2017 were identified. After applying the exclusion criteria, 170,416 men were enrolled. The study cohort was divided into ADT and non-ADT groups by individual matching followed by propensity score matching (PSM). Study outcomes were incidence of all male cancers. Cox proportional hazard regression models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of events.

Results: During a median follow-up of 4.5 years, a total of 11,059 deaths (6,329 in the ADT group and 4,730 in the non-ADT group) after PSM were found. After PSM, the overall all-cause of secondary cancer incidence risk of the ADT group was higher than that of the non-ADT group (HR: 1.312, 95% CI: 1.23-1.36; adjusted HR: 1.344, 95% CI: 1.29-1.40). The ADT group showed higher risk of overall brain and other central nervous system (CNS) cancer-specific incidence than the non-ADT group (adjusted HR: 1.648, 95% CI: 1.21-2.24). The ADT group showed lower risks of overall cancer-specific incidence for stomach, colon/rectum, liver/inflammatory bowel disease (IBD), gall bladder/extrahepatic bile duct, lung, bladder, and kidney cancers than the non-ADT group. When the duration of ADT was more than 2 years of ADT, the ADT group showed higher risk of cancer-specific incidence for brain and other CNS cancers but lower risk of cancer-specific incidence for liver/IBD and lung cancers than the non-ADT group.

Conclusions: This study demonstrates that ADT could affect cancer-specific incidence for various cancers.

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前列腺癌雄激素剥夺疗法后的继发性癌症：一项全国性研究。

目的：雄激素信号传导与多种继发性癌症有关，这些癌症可能有望通过雄激素剥夺疗法（ADT）进行治疗。本研究在全国范围内的人群队列中调查了 ADT 的使用是否与前列腺癌以外的其他继发性癌症有关：在 2002 年 1 月 1 日至 2017 年 12 月 31 日期间，共发现 278434 名新诊断为前列腺癌的男性。在应用排除标准后，170416 名男性被纳入研究。研究队列通过个体匹配和倾向得分匹配（PSM）分为ADT组和非ADT组。研究结果为所有男性癌症的发病率。采用 Cox 比例危险回归模型估算调整后的危险比 (HR) 和事件的 95% 置信区间 (CI)：在中位随访 4.5 年期间，共发现 11 059 例 PSM 后死亡病例（ADT 组 6 329 例，非 ADT 组 4 730 例）。PSM 后，ADT 组的全因继发性癌症发病风险总体高于非 ADT 组（HR：1.312，95% CI：1.23-1.36；调整后 HR：1.344，95% CI：1.29-1.40）。与非 ADT 组相比，ADT 组发生脑癌和其他中枢神经系统（CNS）癌症特异性总发病率的风险更高（调整后 HR：1.648，95% CI：1.21-2.24）。与非 ADT 组相比，ADT 组胃癌、结肠癌/直肠癌、肝癌/炎症性肠病 (IBD)、胆囊癌/肝外胆管癌、肺癌、膀胱癌和肾癌的总体癌症特异性发病风险较低。当ADT持续时间超过2年时，与非ADT组相比，ADT组的脑癌和其他中枢神经系统癌症特异性发病风险较高，但肝癌/肠道炎症性胆管疾病和肺癌特异性发病风险较低：本研究表明，ADT 可影响各种癌症的特异性发病率。

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