Lee Hakmin, Kuk Harim, Byun Seok-Soo, Lee Sang Eun, Hong Sung Kyu
Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.
PLoS One. 2015 Apr 21;10(4):e0124761. doi: 10.1371/journal.pone.0124761. eCollection 2015.
The effect of diabetes mellitus (DM) on prostate cancer (PCa) outcome remains controversial. Thus, we investigated the association of DM history, glycemic control, and metformin use with oncologic outcomes after radical prostatectomy (RP).
We reviewed the records of 746 contemporary patients who had hemoglobin A1c (HbA1c) measured within the 6 months preceding RP. The associations between clinical variables and risk of adverse pathological features and biochemical recurrence (BCR) were tested using a multivariate logistic regression and multiple Cox-proportional hazards model, respectively. BCR was defined as prostatic specific antigen (PSA) > 0.2 ng/mL in 2 consecutive tests.
There were no significant differences in the rates of adverse pathologic features and BCR-free survival between patients with (n = 209) and without (n = 537) a history of DM diagnosis (all p > 0.05). In multivariate analyses, high HbA1c level (≥ 6.5%) was significantly related with high pathologic Gleason score (≥ 4+3; odds ratio [OR] 1.704, p = 0.019) and BCR-free survival (OR 1.853, p = 0.007). Metformin use was not associated with BCR-free survival (OR 0.662, p = 0.125).
Poor glycemic control was significantly associated with BCR after RP. Meanwhile, metformin use was not associated with biochemical outcome after RP. Further investigation would be needed to identify exact mechanism underlying the impact of glycemic control on PCa treatment outcome.
糖尿病（DM）对前列腺癌（PCa）预后的影响仍存在争议。因此，我们研究了糖尿病病史、血糖控制情况以及二甲双胍的使用与根治性前列腺切除术（RP）后肿瘤学预后之间的关联。
我们回顾了746例当代患者的记录，这些患者在RP前6个月内测量了糖化血红蛋白（HbA1c）。分别使用多因素逻辑回归和多因素Cox比例风险模型测试临床变量与不良病理特征风险和生化复发（BCR）之间的关联。BCR定义为连续两次检测中前列腺特异性抗原（PSA）>0.2 ng/mL。
有糖尿病诊断史的患者（n = 209）和无糖尿病诊断史的患者（n = 537）之间，不良病理特征发生率和无BCR生存率无显著差异（所有p>0.05）。在多因素分析中，高HbA1c水平（≥6.5%）与高病理Gleason评分（≥4+3；比值比[OR]1.704，p = 0.019）和无BCR生存率显著相关（OR 1.853，p = 0.007）。二甲双胍的使用与无BCR生存率无关（OR 0.662，p = 0.125）。
血糖控制不佳与RP后BCR显著相关。同时，二甲双胍的使用与RP后的生化结局无关。需要进一步研究以确定血糖控制对PCa治疗结局影响的确切机制。
