前列腺癌去势疗法与糖尿病相关性的Meta分析

Meta-analysis of androgen deprivation therapy for prostate cancer related with diabetes

目的探讨去势疗法是否会增加前列腺癌(PCa)患者罹患糖尿病的风险。方法系统检索Medline、Embase、Cochrane Library Central关于去势疗法(ADT)应用于PCa并报道该治疗与糖尿病相关性的临床试验研究,对文献进行数据提取及Meta分析。结果共8项临床研究,涉及65 695名应用ADT及91 893名未应用去势疗法(non-ADT)的PCa患者纳入分析。应用ADT的患者其糖尿病的发病率较non-ADT者高出39%[RR=1.39,95%CI(1.27~1.53),P<0.01];亚组分析发现,不同的ADT对糖尿病发病率亦有不同的相关性,促雄性激素释放激素抑制剂能明显增加PCa患者罹患糖尿病的风险[RR=1.45,95%CI(1.36~1.54),P<0.01];促雄性激素释放激素抑制剂联合口服抗雄性激素药物[RR=1.40,95%CI(1.01~1.93),P<0.01],以及睾丸切除术也可明显增加糖尿病患病的风险[RR=1.34,95%CI(1.20~1.50),P<0.01],而单纯服用抗雄性激素的药物则与糖尿病无明显相关性[RR=1.33,95%CI(0.75~2.36),P=0.33]。结论 ADT可明显增加PCa罹患糖尿病的风险,提示临床应用该疗法需考虑采取相应的预防措施。

Objective To examine whether androgen deprivation therapy（ADT） is associated with increased risk of diabetes in men with prostate cancer（PCa）. Methods The study data were systematically searched from Medline, Embase, and Cochrane Library Central Register. Studies comparing ADT vs control aimed at treating PCa, reporting diabetes as outcome were included. Results Eight studies met inclusion criteria with a total of 65 695 ADT users and 91 893 non-ADT users investigating the relationship between ADT and diabetes. The incidence of diabetes was 39% higher in ADT groups, and significant association was observed in overall analysis [RR = 1.39, 95%CI（1.27-1.53）, P〈0.01]. In subgroup-analyses stratified by ADT types, diabetes was found to be significantly associated with gonadotropin-releasing hormone（Gn RH） alone [RR = 1.45, 95%CI（1.36-1.54）, P〈0.01）, Gn RH plus oral anti-androgen（AA） [RR = 1.40, 95%CI（1.01-1.93）, P〈0.01] and Orchiectomy [RR = 1.34, 95%CI（1.20-1.50）, P〈0.01], but not with AA alone [RR = 1.33, 95%CI（0.75-2.36）, P = 0.33]. Conclusions ADT, especially Gn RH alone, Gn RH plus AA and orchiectomy can increase the incidence of diabetes in patients with PCa.