Abstract：
OBJECTIVE: With new therapies for metastatic prostate cancer, patients are living longer, increasing the need for better understanding of the impact of comorbid disease. Prescription medications may risk-stratify patients independent of established methods, such as the Charlson Comorbidity Index (CCI) and guide treatment selection.
METHODS: In a nationwide retrospective study of US Veterans, we used multivariable logistic regression and Cox proportional hazard modeling to evaluate the association between number and class of prescription medications and overall survival (OS) with age, race, body-mass index, prostate specific antigen (PSA), and Charlson comorbidities as covariates in veterans treated for de novo metastatic hormone sensitive prostate cancer (mHSPC) between 2010-2021.
RESULTS: Among 8,434 Veterans, a median of nine medications and five medication classes were filled in the year prior to initial treatment with abiraterone or enzalutamide for mHSPC. Veterans on 1-4 medications had an average survival of 38 months compared to 5-9 medicines (33 months), 10-14 medicines (27 months), and 15+ medicines (22 months) (p<0.001). After adjusting for age, race, body mass index (BMI), PSA, CCI, and year of diagnosis, both the number of medications and medication classes were associated with increased mortality. The adjusted hazard ratio (aHR) [95% confidence interval (CI)] was 1.03 (1.02-1.03) for the number of medications and 1.05 (1.04-1.07) for medication classes. Medications within ATC B (blood/blood forming organs), ATC C (cardiovascular), and ATC N (nervous) were associated with worse OS, with aHRs of 1.14 (1.07, 1.21), 1.14 (1.06, 1.22), and 1.12 (1.06, 1.19), respectively.
CONCLUSIONS: The number and class of medications were independently associated with overall survival in patients undergoing treatment for mHSPC. With new therapies for advanced prostate cancer, patients are living longer, highlighting the need for a better understanding of the impact of comorbid diseases. Simple methods to assess disease burden and prognosticate survival have the potential to guide treatment decisions.
METHODS: In a nationwide retrospective study of US Veterans, we used multivariable logistic regression and Cox proportional hazard modeling to evaluate the association between number and class of prescription medications and overall survival (OS) with age, race, body-mass index, prostate specific antigen (PSA), and Charlson comorbidities as covariates in veterans treated for de novo metastatic hormone sensitive prostate cancer (mHSPC) between 2010-2021.
RESULTS: Among 8,434 Veterans, a median of nine medications and five medication classes were filled in the year prior to initial treatment with abiraterone or enzalutamide for mHSPC. Veterans on 1-4 medications had an average survival of 38 months compared to 5-9 medicines (33 months), 10-14 medicines (27 months), and 15+ medicines (22 months) (p<0.001). After adjusting for age, race, body mass index (BMI), PSA, CCI, and year of diagnosis, both the number of medications and medication classes were associated with increased mortality. The adjusted hazard ratio (aHR) [95% confidence interval (CI)] was 1.03 (1.02-1.03) for the number of medications and 1.05 (1.04-1.07) for medication classes. Medications within ATC B (blood/blood forming organs), ATC C (cardiovascular), and ATC N (nervous) were associated with worse OS, with aHRs of 1.14 (1.07, 1.21), 1.14 (1.06, 1.22), and 1.12 (1.06, 1.19), respectively.
CONCLUSIONS: The number and class of medications were independently associated with overall survival in patients undergoing treatment for mHSPC. With new therapies for advanced prostate cancer, patients are living longer, highlighting the need for a better understanding of the impact of comorbid diseases. Simple methods to assess disease burden and prognosticate survival have the potential to guide treatment decisions.
摘要：
目的：针对转移性前列腺癌的新疗法，病人活得更长，越来越需要更好地了解共病的影响。处方药可以独立于既定的方法对患者进行风险分层，如Charlson合并症指数(CCI)和指导治疗选择。
方法：在一项针对美国退伍军人的全国性回顾性研究中，我们使用多变量逻辑回归和Cox比例风险模型来评估处方药的数量和类别以及总生存期（OS）与年龄之间的关系，种族,身体质量指数,前列腺特异性抗原（PSA），和Charlson合并症作为协变量在2010年至2021年间治疗新生转移性激素敏感性前列腺癌（mHSPC）的退伍军人中。
结果：在8,434名退伍军人中，在接受阿比曲酮或恩扎鲁他胺治疗mHSPC的初始治疗前一年,我们填补了9种药物和5种药物的中位数.使用1-4种药物的退伍军人平均生存期为38个月，而使用5-9种药物（33个月）。10-14种药物（27个月），和15+药物（22个月）（p<0.001）。在调整了年龄之后,种族,体重指数（BMI），PSA,CCI和诊断年份，药物数量和药物类别均与死亡率增加相关.调整后的危险比（aHR）[95％置信区间（CI）]为药物数量1.03（1.02-1.03），药物类别为1.05（1.04-1.07）。ATCB（血液/造血器官）内的药物，ATCC（心血管），ATCN（紧张）与OS恶化有关，AHR为1.14（1.07，1.21），1.14(1.06,1.22),和1.12（1.06，1.19），分别。
结论：在接受mHSPC治疗的患者中，药物的数量和种类与总生存期独立相关。有了治疗晚期前列腺癌的新疗法，病人活得更长，强调需要更好地了解合并症的影响。评估疾病负担和预后生存的简单方法有可能指导治疗决策。
方法：在一项针对美国退伍军人的全国性回顾性研究中，我们使用多变量逻辑回归和Cox比例风险模型来评估处方药的数量和类别以及总生存期（OS）与年龄之间的关系，种族,身体质量指数,前列腺特异性抗原（PSA），和Charlson合并症作为协变量在2010年至2021年间治疗新生转移性激素敏感性前列腺癌（mHSPC）的退伍军人中。
结果：在8,434名退伍军人中，在接受阿比曲酮或恩扎鲁他胺治疗mHSPC的初始治疗前一年,我们填补了9种药物和5种药物的中位数.使用1-4种药物的退伍军人平均生存期为38个月，而使用5-9种药物（33个月）。10-14种药物（27个月），和15+药物（22个月）（p<0.001）。在调整了年龄之后,种族,体重指数（BMI），PSA,CCI和诊断年份，药物数量和药物类别均与死亡率增加相关.调整后的危险比（aHR）[95％置信区间（CI）]为药物数量1.03（1.02-1.03），药物类别为1.05（1.04-1.07）。ATCB（血液/造血器官）内的药物，ATCC（心血管），ATCN（紧张）与OS恶化有关，AHR为1.14（1.07，1.21），1.14(1.06,1.22),和1.12（1.06，1.19），分别。
结论：在接受mHSPC治疗的患者中，药物的数量和种类与总生存期独立相关。有了治疗晚期前列腺癌的新疗法，病人活得更长，强调需要更好地了解合并症的影响。评估疾病负担和预后生存的简单方法有可能指导治疗决策。
