Impact of androgen deprivation therapy on mortality of prostate cancer patients with COVID-19: a propensity score-based analysis
Mateus Bringel Oliveira Duarte, Frederico Leal, Juliana Luz Passos Argenton, José Barreto Campello Carvalheira
Infectious Agents and Cancer, doi:10.1186/s13027-021-00406-y
Background: Previous studies hypothesized that androgen deprivation therapy (ADT) may reduce severe acute respiratory syndrome coronavirus 2 (SARS-COV2) infectivity. However, it is unknown whether there is an association between ADT and a higher survival in prostate cancer patients with COVID-19.
Methods: We performed a retrospective analysis of prostate cancer (PC) patients hospitalized to treat COVID-19 in Brazil's public health system. We compared patients with the active use of ADT versus those with non-active ADT, past use. We constructed propensity score models of patients in active versus non-active use of ADT. All variables were used to derive propensity score estimation in both models. In the first model we performed a pair-matched propensity score model between those under active and non-active use of ADT. To the second model we initially performed a multivariate backward elimination process to select variables to a final inverse-weight adjusted with double robust estimation model.
Results: We analyzed 199 PC patients with COVID-19 that received ADT. In total, 52.3% (95/199) of our patients were less than 75 years old, 78.4% (156/199) were on active ADT, and most were using a GnRH analog (80.1%; 125/156). Most of patients were in palliative treatment (89.9%; 179/199). Also, 63.3% of our cohort died from COVID-19. Fortyeight patients under active ADT were pair matched against 48 controls (non-active ADT). All patients (199) were analyzed in the double robust model. ADT active use were not protective factor in both inverse-weight based propensity score (OR 0.70, 95% CI 0.38-1.31, P = 0.263), and pair-matched propensity score (OR 0.67, 95% CI 0.27-1.63, P = 0.374) models. We noticed a significant imbalance in the propensity score of patients in active and those in non-active ADT, with important reductions in the differences after the adjustments.
Conclusions: The active use of ADT was not associated with a reduced risk of death in patients with COVID-19.
Supplementary Information The online version contains supplementary material available at https:// doi. org/ 10. 1186/ s13027-021-00406-y. Additional file 1. Supplemental Table 1 . Baseline variables of active and non-active androgen deprivation therapy groups and standardized mean differences after propensity score-based pair matching. S1 . Standardized mean difference. The mean difference represents the difference between propensity score inside the variable before and after pair matching.
Additional file 2. Figure Additional file 3. Figure S2 . Cumulative distribution of logit propensity score. The graphs summarize the cumulative distribution of logit propensity score, as well as the difference between active and non-active groups before and after matching. Additional file 4. Figure S3 . Density of propensity score distribution. The figure summarizes the distribution of propensity score applied in the double robust estimation model according to the use of androgen deprivation therapy (ADT).
Authors' contributions
Declarations Ethics approval and consent to participate The project was submitted and approved by our institutional ethics (Comitê de Ética em Pesquisa (CEP) da Universidade Estadual de Campinas) commitment and the consent form was waived.
Consent for publication The project was submitted and approved by our institutional ethics (Comitê de Ética em Pesquisa (CEP) da Universidade Estadual de Campinas) commitment and the consent form was waived.
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