Discrepancies on the association between androgen deprivation therapy for prostate cancer and subsequent dementia: meta-analysis and meta-regression
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Jae Heon Kim1,2,*, Bora Lee3,4,*, Deok Hyun Han1, Kyoung Jin Chung1, In Gab Jeong1 and Benjamin I. Chung1
1Department of Urology, Stanford University Medical Center, Stanford, CA, USA
2Department of Urology, Soonchunhyang University Hospital, Soonchuhyang University Medical College, Seoul, Korea
3Department of Biostatistics, Clinical Trial Center, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
4Department of Statistics, Graduate School of Chung-Ang University, Seoul, Korea
*These authors contributed equally to this work
Jae Heon Kim, email: [email protected]
Keywords: androgen deprivation therapy, prostate cancer, dementia, alzheimer’s disease
Received: June 22, 2017 Accepted: August 04, 2017 Published: August 22, 2017
Limited literature exists on the association between androgen deprivation therapy (ADT) for prostate cancer (PCa) and subsequent dementia and the study conclusions are in conflicts with one another. We searched several cohort databases from 1960 to 2017 for observational or prospective studies that reported on an association between ADT for PCa and subsequent dementia. A meta-analysis was performed to cumulatively determine the association between ADT and dementia including Alzheimer’s disease using an incidence rate ratio (IRR), crude hazard ratio (HR), and adjusted HR. Seven studies were eligible for the meta-analysis, with the inclusion of a total of 90, 543 prostate cancer patients. The pooled overall IRR, crude HR, and adjusted HR were 1.78 [95% confidence interval (CI): 1.51–2.10)], 1.80 (95% CI: 1.05–3.10), and 1.59 (95% CI: 1.16–2.18), respectively. A meta-regression analysis showed that the crude HR was affected by both follow -up duration and lag time in the univariate model (p = < 0.001). However, IRR and adjusted HR were not affected by these moderators. The overall outcomes of IRR, crude HR, and adjusted HR were found to be balanced in the sensitivity analysis. A positive association was demonstrated between ADT and the subsequent incidence of dementia in this meta-analysis. Methodological difference including follow-up duration and the time lag could be related with the discrepancies.
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