未得到良好控制的糖尿病会增加接受根治性前列腺切除术的男性发生转移和去势抵抗性前列腺癌的风险：来自 SEARCH 数据库的结果。
Poorly controlled diabetes increases the risk of metastases and castration-resistant prostate cancer in men undergoing radical prostatectomy: Results from the SEARCH database.
机构信息
David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina.
出版信息
Cancer. 2019 Aug 15;125(16):2861-2867. doi: 10.1002/cncr.32141. Epub 2019 Apr 29.
BACKGROUND
Although diabetes is inversely related to prostate cancer (PC) risk, to the authors' knowledge the impact of glycemic control on PC progression is unknown. In the current study, the authors tested the association between hemoglobin A1c (HbA1c) and long-term PC outcomes among diabetic men undergoing radical prostatectomy (RP).
METHODS
The authors retrospectively reviewed data regarding men undergoing RP from 2000 to 2017 at 8 Veterans Affairs hospitals. Diabetic patients were identified using International Classification of Diseases, Ninth Revision (ICD-9) codes (250.x) or by an HbA1c value >6.5% at any time before RP. Cox models tested the association between HbA1c and biochemical disease recurrence (BCR), castration-resistant PC (CRPC), metastases, PC-specific mortality, and all-cause mortality. The model for BCR was adjusted for multiple variables. Due to limited events, models for long-term outcomes were adjusted for biopsy grade and prostate-specific antigen only.
RESULTS
A total of 1409 men comprised the study population. Of these, 699 patients (50%) had an HbA1c value <6.5%, 631 (45%) had an HbA1c value of 6.5% to 7.9%, and 79 (6%) had an HbA1c value ≥8.0%. Men with an HbA1c value ≥8.0% were younger (P < .001) and more likely to be black (P = .013). The median follow-up after RP was 6.8 years (interquartile range, 3.7-10.6 years). On multivariable analysis, HbA1c was not found to be associated with BCR. However, a higher HbA1c value was associated with metastasis (hazard ratio [HR], 1.21; 95% CI, 1.02-1.44 [P = .031]) and CRPC (HR, 1.27; 95% CI, 1.03-1.56 [P = .023]). Although not statistically significant, there were trends between higher HbA1c and risk of PC-specific mortality (HR, 1.24; 95% CI, 0.99-1.56 [P = .067]) and all-cause mortality (HR, 1.09; 95% CI, 0.99-1.19 [P = .058]).
CONCLUSIONS
Among diabetic men undergoing RP, a higher HbA1c value was associated with metastases and CRPC. If validated in larger studies with longer follow-up, future research should test whether better glycemic control improves long-term PC outcomes.
背景
尽管糖尿病与前列腺癌（PC）风险呈负相关，但作者所知，血糖控制对 PC 进展的影响尚不清楚。在目前的研究中，作者检测了血红蛋白 A1c（HbA1c）与接受根治性前列腺切除术（RP）的糖尿病男性长期 PC 结局之间的关联。
方法
作者回顾性分析了 2000 年至 2017 年在 8 家退伍军人事务部医院接受 RP 的男性的数据。通过国际疾病分类，第九修订版（ICD-9）代码（250.x）或在 RP 前任何时间 HbA1c 值>6.5%来识别糖尿病患者。Cox 模型检测了 HbA1c 与生化疾病复发（BCR）、去势抵抗性 PC（CRPC）、转移、PC 特异性死亡率和全因死亡率之间的关联。BCR 的模型调整了多个变量。由于事件有限，长期结局模型仅调整了活检分级和前列腺特异性抗原。
结果
共有 1409 名男性构成了研究人群。其中，699 名患者（50%）HbA1c 值<6.5%，631 名（45%）HbA1c 值为 6.5%至 7.9%，79 名（6%）HbA1c 值≥8.0%。HbA1c 值≥8.0%的男性更年轻（P<0.001），且更可能是黑人（P=0.013）。RP 后中位随访时间为 6.8 年（四分位间距，3.7-10.6 年）。多变量分析显示，HbA1c 与 BCR 无关。然而，较高的 HbA1c 值与转移（风险比[HR]，1.21；95%置信区间，1.02-1.44[P=0.031]）和 CRPC（HR，1.27；95%置信区间，1.03-1.56[P=0.023]）相关。虽然没有统计学意义，但较高的 HbA1c 值与 PC 特异性死亡率（HR，1.24；95%置信区间，0.99-1.56[P=0.067]）和全因死亡率（HR，1.09；95%置信区间，0.99-1.19[P=0.058]）之间存在趋势。
结论
在接受 RP 的糖尿病男性中，较高的 HbA1c 值与转移和 CRPC 相关。如果在具有更长随访时间的更大研究中得到验证，未来的研究应测试更好的血糖控制是否能改善长期的 PC 结局。
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