β受体阻断剂与高危前列腺癌患者死亡率降低有关

《欧洲泌尿外科》杂志发表的一项研究显示，转移性高危前列腺癌患者使用β受体阻断剂与前列腺癌特异性死亡率降低有关，并且独立于他汀类或乙酰水杨酸的使用(Eur. Urol. 2014;635-41)。

基于上述结果，挪威奥斯陆大学医院癌症研究所的Helene Hartvedt Grytli等研究者建议在大型注册数据库中进一步探讨β受体阻断剂的使用。

研究者从挪威癌症注册数据库中获取了2004~2009年间被诊断为前列腺癌的男性数据，然而利用受试者的身份证号，将这些数据与挪威处方数据库中的β受体阻断剂、他汀类和乙酰水杨酸(ASA)处方信息进行匹配。在诊断前后曾使用至少1份上述药物处方的患者即被视为上述药物的使用者。死亡数据来自挪威癌症注册数据库。共有3,561名男性被纳入分析，排除标准包括：患有低危或中危疾病，计划接受根治性前列腺切除术或放疗。

多变量模型分析结果显示，β受体阻断剂的使用与前列腺癌特异性死亡风险降低有关(校正后亚危险比，0.79；95%可信区间，0.68~0.91；P=0.001)。中位随访时间为39个月。

在β受体阻断剂使用者中，72%还使用了ASA或他汀类。研究者进行了一项生存分析，校正了这些药物的使用情况，以辨别任何潜在混杂效应。在单独加以分析时，他汀类的使用和ASA的使用均与前列腺癌特异性死亡率降低有关。校正这两类药物的使用情况后，使用β受体阻断剂的亚危险比并未发生明显改变。

研究者承认这项研究有潜在的局限性：“未知的患者特征可能对研究结果产生了混杂影响，有必要开展更多的观察性研究以确定β受体阻断剂的使用是否对前列腺癌进展和生存有独立影响。”

这项研究获得了挪威东南地区卫生局、奥斯陆大学医院和奥斯陆大学的资助。

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By: MADHU RAJARAMAN, Internal Medicine News Digital Network

The use of beta-blockers in men with metastatic and high-risk prostate cancer was associated with a reduced risk of prostate cancer–specific mortality independent of statin or acetylsalicylic acid use, according to a study published in European Urology.

Given these results, beta-blocker use should be further investigated where large registries are available, wrote Dr. Helene Hartvedt Grytli of the Institute of Cancer Research at Oslo University Hospital and her coinvestigators. "This is the first study to assess the association between beta-blocker use and prostate cancer–specific survival in a large cohort of men with known disease aggressiveness at diagnosis," they wrote.

The researchers obtained data from the Cancer Registry of Norway for men diagnosed with prostate cancer between 2004 and 2009. They coupled these data, using participants’ national identification numbers, with information from the Norwegian Prescription Database on filled prescriptions for beta-blockers, statins, and acetylsalicylic acid (ASA). Patients were considered users of these agents if they had filled at least one prescription of the respective drug both before and after diagnosis.

Mortality data were obtained from the Cancer Registry of Norway. A total of 3,561 men were eligible for analysis after exclusion criteria were accounted for; the criteria included having low- or intermediate-risk disease and planned treatment with either radical prostatectomy or radiation therapy.

Beta-blocker use was independently associated with a reduced risk of prostate cancer–specific mortality in a multivariable model (adjusted subhazard ratio, 0.79; 95% confidence interval, 0.68-0.91; P = .001). The median follow-up time was 39 months (Eur. Urol. 2014;635-41).

Among beta-blocker users, 72% also used either ASA or statins. The investigators performed a survival analysis, adjusting for the use of these drugs to study any possible confounding effect. Statin use and ASA use were both associated with a reduction in prostate cancer–specific mortality when each drug was analyzed separately. Adjustment for the use of these drug classes did not substantially change the subhazard ratio for beta-blocker use.

The researchers did acknowledge a possible limitation of their study: "Unknown patient characteristics of this patient group might have confounded our results, and additional observation studies are warranted to establish whether beta-blocker use has an independent effect on prostate cancer progression and survival."

The study was funded by the South-Eastern Norway Regional Health Authority, Oslo University Hospital, and the University of Oslo.