Department of Urology, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, 463-707, Gyeonggi-do, Korea.
Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
Sci Rep. 2021 Jun 7;11(1):12002. doi: 10.1038/s41598-021-91310-3.
To evaluate the clinical impact of preoperative glycemic status upon oncological and functional outcomes after radical prostatectomy in patients with localized prostate cancer, we analyzed the data of 2664 subjects who underwent radical prostatectomy with preoperative measurement of hemoglobin A1c within 6 months before surgery. The possible association between high hemoglobin A1c (≥ 6.5 ng/dL) and oncological/functional outcomes was evaluated. Among all subjects, 449 (16.9%) were categorized as the high hemoglobin A1c group and 2215 (83.1%) as the low hemoglobin A1c group. High hemoglobin A1c was associated with worse pathological outcomes including extra-capsular extension (HR 1.277, 95% CI 1.000-1.630, p = 0.050) and positive surgical margin (HR 1.302, 95% CI 1.012-1.674, p = 0.040) in multi-variate regression tests. Kaplan-Meier analysis showed statistically shorter biochemical recurrence-free survival in the high hemoglobin A1c group (p < 0.001), and subsequent multivariate Cox proportional analyses revealed that high hemoglobin A1c is an independent predictor for shorter BCR-free survival (HR 1.135, 95% CI 1.016-1.267, p = 0.024). Moreover, the high hemoglobin A1c group showed a significantly longer incontinence-free survival than the low hemoglobin A1c group (p = 0.001), and high preoperative hemoglobin A1c was also an independent predictor for longer incontinence-free survival in multivariate Cox analyses (HR 0.929, 95% CI 0.879-0.981, p = 0.008). The high preoperative hemoglobin A1c level was independently associated with worse oncological outcomes and also with inferior recovery of urinary continence after radical prostatectomy.
为了评估术前血糖状态对局限性前列腺癌患者根治性前列腺切除术后肿瘤学和功能结局的临床影响，我们分析了 2664 例接受根治性前列腺切除术且术前在手术前 6 个月内测量糖化血红蛋白的患者的数据。评估了高血红蛋白 A1c（≥6.5ng/dL）与肿瘤学/功能结局之间的可能关联。在所有患者中，449 例（16.9％）被归类为高血红蛋白 A1c 组，2215 例（83.1％）为低血红蛋白 A1c 组。多变量回归检验显示，高血红蛋白 A1c 与较差的病理结果相关，包括包膜外延伸（HR 1.277，95％CI 1.000-1.630，p=0.050）和阳性手术切缘（HR 1.302，95％CI 1.012-1.674，p=0.040）。Kaplan-Meier 分析显示，高血红蛋白 A1c 组的生化无复发生存率明显较短（p<0.001），随后的多变量 Cox 比例分析显示，高血红蛋白 A1c 是较短 BCR 无复发生存的独立预测因子（HR 1.135，95％CI 1.016-1.267，p=0.024）。此外，高血红蛋白 A1c 组的无尿失禁生存率明显长于低血红蛋白 A1c 组（p=0.001），多变量 Cox 分析显示，高术前血红蛋白 A1c 也是无尿失禁生存率较长的独立预测因子（HR 0.929，95％CI 0.879-0.981，p=0.008）。高术前血红蛋白 A1c 水平与较差的肿瘤学结果相关，并且与根治性前列腺切除术后尿控恢复不良相关。
