本帖最後由 goodcat1111 於 2009-5-13 17:23 編輯
作者：Martha Kerr
出處：WebMD醫學新聞
April 28, 2009（伊利諾州芝加哥）－根據Shared Equal Access Regional Cancer Hospital（SEARCH）資料庫的結果，經根除性前列腺切除術的前列腺癌男性，在服用statins類藥物後，相較未服用statins類藥物者，能降低30%生化復發機率，也就是前列腺特異抗原（PSA）上升的風險。
SEARCH資料庫的這項發現在美國泌尿科醫學會第104屆年會由主要研究者Robert J. Hamilton發表，他是安大略多倫多大學的醫學博士，這項研究是他在北卡羅萊納州杜漢杜克大學外科部泌尿科擔任醫師助理時所指導的研究。
這個研究收納了1,325位在SEARCH資料庫中，經歷根除性前列腺切除術的患者；在此世代研究中，有237位（18%）在手術時服用statins類藥物，其餘1,088位（82%）未服用。
服用statins類藥物的病患，平均比未服用者晚2.0年經歷根除性前列腺切除術；服用者平均在2004年動手術，而未服用者則在2002年動手術。服用statins類藥物病患，在臨床上被診斷為較不嚴重的等級，服用者中有67%，未服用者有58%被診斷為T1分期（P=0.009）。服用statins類藥物病患（6.2 ng/mL）的PSA值比未服用者（6.9 ng/mL; P = .04）低。
服用statins類藥物的病患，其試驗前活組織切片的Gleason評分較高，有50%的statins類藥物服用者以及38%的未服用者Gleason評分超過7分（P=0.001）。
Hamilton博士向與會者表示，經過校正多變項臨床與病理危險因子，手術後5年，statins類藥物可以降低30%前列腺特異抗原復發率（危險比值為0.70，95%信賴區間0.50~0.97；P=0.03）。生化復發是指PSA增加0.2 ng/mL以上。
在發表結束後，Hamilton博士向Medscape泌尿學表示，Statins類藥物看似無法降低整體攝護腺癌的風險，但與降低侵犯性前列腺癌風險有關。他指出，之前的研究顯示statins類藥物可以抑制癌症細胞生長；statins類藥物也能改善根除性前列腺切除術後病患的預後。
他推測，statins類藥物治療的好處在於降低發炎反應，這可能與降低血脂的效果、或雄性荷爾蒙或是其他細胞路徑有關。
Hamilton博士指出，儘管statin服用者有較高的Gleason評分、年齡較大、且在診斷時罹患較為嚴重的疾病，但相較於未使用statins類藥物的病患，其術後一年內的生化再發風險仍然是較低的；使用statins類藥物時間最長的患者獲益最大。
Hamilton博士表示，很重要的是，在我們的資料庫中，可能沒有計算到可能影響我們發現的並存疾病，但如果有這樣的因素，那麼，相較於未使用statins類藥物的病患，使用statins類藥物者的病情應該會較嚴重，然而，截至目前，他們發生生化再發的風險仍然是較低的。
這項研究有部分限制，首先，這不是一項隨機分派研究，其後續追蹤時間很短，且並未校正使用statins類藥物的種類與劑量。下一步是在手術後開始投予statins類藥物。
堪撒斯州勘撒斯大學醫學院泌尿科主任與教授J. Brantley Thrasher醫師向Medscape泌尿學表示，我們有證明我們想法的證據；未來我們必須將重點放在設計嚴謹的隨機臨床研究上，在我們知道statins類藥物是否應該處方用於預防前列腺癌再發之前，這將需要至少5到10年的研究時間。
Hamilton博士與Thrasher醫師表示沒有相關資金上的往來。
AUA 2009: Statin Use Cuts Risk for Biochemical Recurrence After Radical Prostatectomy
By Martha Kerr
Medscape Medical News
April 28, 2009 (Chicago, Illinois) — Men with prostate cancer who undergo radical prostatectomy and who are concurrently taking statin therapy have a 30% lower risk for biochemical recurrence, shown by an increase in prostate-specific antigen (PSA) levels after surgery, than their counterparts who are not taking statin medication, according to results from a study of the Shared Equal Access Regional Cancer Hospital (SEARCH) database.
Findings from SEARCH were presented here at the American Urological Association 104th Annual Scientific Meeting by lead investigator Robert J. Hamilton, MD, from the University of Toronto in Ontario, who conducted the study while he was a research fellow in the Department of Surgery, Division of Urology, at Duke University School of Medicine in Durham, North Carolina.
The study involved 1325 men in the SEARCH database who underwent radical prostatectomy. Of the cohort, 237 men (18%) were taking statin therapy at the time of surgery and 1088 (82%) were not.
Statin users were on average 2.0 years older (P?< .001) and had undergone radical prostatectomy more recently; the median year of surgery was 2004 for users and 2002 for nonusers. Statin users were diagnosed at lower clinical stages, with 67% of users and 58% of nonusers diagnosed with T1 disease (P?= .009). PSA levels were lower among users (6.2?ng/mL) than among nonusers (6.2?ng/mL; P?= .04).
Statin users tended to have higher biopsy Gleason scores at baseline, with 50% of statin users and 38% of nonusers having a Gleason score of 7 or higher (P?= .001).
"After adjustment for multiple clinical and pathological factors, statin use was associated with a 30% lower risk of PSA recurrence" in the approximately 5 years since surgery" (hazard ratio, 0.70; 95% confidence interval, 0.50 - 0.97; P?= .03), Dr. Hamilton told meeting attendees. Biochemical recurrence was defined as an increase in PSA level of 0.2?ng/mL or more.
"Statins don't appear to reduce the risk of prostate cancer overall, but they do appear to be associated with a reduced risk of advanced aggressive cancers," he told Medscape Urology after his presentation. He said previous studies have shown that statins inhibit cancer-cell growth.
"Statins also appear to improve outcome after radiation treatment for prostate cancer," he added.
The benefit of statin therapy could be attributable to a reduction in inflammation, to their lipid-lowering effect, or to their effect on androgens or some other cell pathway, he speculated.
"Despite statin users having higher Gleason scores at baseline, older age, and more advanced disease at diagnosis, the risk of biochemical recurrence was lower in the years after surgery than for nonusers," Dr. Hamilton pointed out. "Those on statins the longest showed the greatest benefit.
"It is important to note that there were likely comorbidities not captured in our database that could have influenced our findings, but if anything, those on statins would be sicker than those who were not?.?.?. yet they had a lower risk of biochemical recurrence," Dr. Hamilton said.
"This study had limitations. It was not a randomized trial, it had a short duration, and the type and dose of statin were not controlled for. The next step is a randomized controlled trial of statins after surgery," he said.
"Here we have proof of concept," J. Brantley Thrasher, MD, professor and chair of the Department of Urology at the University of Kansas School of Medicine in Kansas City, Kansas, told Medscape Urology.
"From here forward, we have to put more emphasis on well-designed clinical trials.?.?.?. These will need to be at least 10 to 15 years in duration?.?.?. before we know whether statins should be prescribed for prevention of prostate cancer recurrence."
Dr. Hamilton and Dr. Thrasher have disclosed no relevant financial relationships.
American Urological Association 104th Annual Scientific Meeting: Abstract 1598. Presented April 27, 2009. |
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