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男性糖尿病患者中常见高风险与有利风险前列腺癌的死亡原因。

Causes of death in men with prevalent diabetes and newly diagnosed high- versus favorable-risk prostate cancer.

机构信息

Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA 02215, USA.

出版信息

Int J Radiat Oncol Biol Phys. 2010 Aug 1;77(5):1329-37. doi: 10.1016/j.ijrobp.2009.06.051. Epub 2009 Oct 30.

DOI:10.1016/j.ijrobp.2009.06.051

PMID:19879061

Abstract

PURPOSE

To determine whether prevalent diabetes mellitus (pDM) affects the presentation, extent of radiotherapy, or prostate cancer (PCa)-specific mortality (PCSM) and whether PCa aggressiveness affects the risk of non-PCSM, DM-related mortality, and all-cause mortality in men with pDM.

METHODS

Between October 1997 and July 2907, 5,279 men treated at the Chicago Prostate Cancer Center with radiotherapy for PCa were included in the study. Logistic and competing risk regression analyses were performed to assess whether pDM was associated with high-grade PCa, less aggressive radiotherapy, and an increased risk of PCSM. Competing risks and Cox regression analyses were performed to assess whether PCa aggressiveness described by risk group in men with pDM was associated with the risk of non-PCSM, DM-related mortality, and all-cause mortality. Analyses were adjusted for predictors of high-grade PCa and factors that could affect treatment extent and mortality.

RESULTS

Men with pDM were more likely (adjusted hazard ratio [AHR], 1.9; 95% confidence interval [CI], 1.3-2.7; p = .002) to present with high-grade PCa but were not treated less aggressively (p = .33) and did not have an increased risk of PCSM (p = .58) compared to men without pDM. Among the men with pDM, high-risk PCa was associated with a greater risk of non-PCSM (AHR, 2.2; 95% CI, 1.1-4.5; p = .035), DM-related mortality (AHR, 5.2; 95% CI, 2.0-14.0; p = .001), and all-cause mortality (AHR, 2.4; 95% CI, 1.2-4.7; p = .01) compared to favorable-risk PCa.

CONCLUSION

Aggressive management of pDM is warranted in men with high-risk PCa.

摘要

目的

确定是否普遍存在的糖尿病（pDM）会影响表现、放疗范围或前列腺癌（PCa）特异性死亡率（PCSM），以及 PCa 的侵袭性是否会影响患有 pDM 的男性的非 PCaSM、DM 相关死亡率和全因死亡率的风险。

方法

1997 年 10 月至 2007 年 7 月期间，共有 5279 名在芝加哥前列腺癌中心接受放疗治疗 PCa 的男性患者被纳入研究。使用逻辑回归和竞争风险回归分析评估 pDM 是否与高级别 PCa、放疗范围不那么积极以及 PCSM 风险增加相关。使用竞争风险和 Cox 回归分析评估患有 pDM 的男性中按风险组描述的 PCa 侵袭性是否与非 PCaSM、DM 相关死亡率和全因死亡率的风险相关。分析调整了高级别 PCa 的预测因素和可能影响治疗范围和死亡率的因素。

结果

患有 pDM 的男性更有可能出现高级别 PCa（调整后的危险比 [AHR]，1.9；95%置信区间 [CI]，1.3-2.7；p =.002），但与没有 pDM 的男性相比，他们的放疗范围不那么积极（p =.33），并且没有增加 PCSM 的风险（p =.58）。在患有 pDM 的男性中，高危 PCa 与非 PCaSM（AHR，2.2；95% CI，1.1-4.5；p =.035）、DM 相关死亡率（AHR，5.2；95% CI，2.0-14.0；p =.001）和全因死亡率（AHR，2.4；95% CI，1.2-4.7；p =.01）的风险增加相关，而不是低危 PCa。