糖尿病与非转移性去势抵抗性前列腺癌男性患者的前列腺癌结局：SEARCH 队列研究结果。
Diabetes and Prostate Cancer Outcomes in Men with Nonmetastatic Castration-Resistant Prostate Cancer: Results from the SEARCH Cohort.
机构信息
Durham Veterans Affairs Health Care System, Durham, North Carolina.
Oregon Health & Science University, Portland, Oregon.
出版信息
Cancer Epidemiol Biomarkers Prev. 2023 Sep 1;32(9):1208-1216. doi: 10.1158/1055-9965.EPI-22-1324.
BACKGROUND
The prognosis of diabetic men with advanced prostate cancer is poorly understood and understudied. Hence, we studied associations between diabetes and progression to metastases, prostate cancer-specific mortality (PCSM) and all-cause mortality (ACM) in men with nonmetastatic castration-resistant prostate cancer (nmCRPC).
METHODS
Data from men diagnosed with nmCRPC between 2000 and 2017 at 8 Veterans Affairs Health Care Centers were analyzed using Cox regression to determine HRs and 95% confidence intervals (CI) for associations between diabetes and outcomes. Men with diabetes were classified according to: (i) ICD-9/10 codes only, (ii) two HbA1c values > 6.4% (missing ICD-9/10 codes), and (iii) all diabetic men [(i) and (ii) combined].
RESULTS
Of 976 men (median age: 76 years), 304 (31%) had diabetes at nmCRPC diagnosis, of whom 51% had ICD-9/10 codes. During a median follow-up of 6.5 years, 613 men were diagnosed with metastases, and 482 PCSM and 741 ACM events occurred. In multivariable-adjusted models, ICD-9/10 code-identified diabetes was inversely associated with PCSM (HR, 0.67; 95% CI, 0.48-0.92) while diabetes identified by high HbA1c values (no ICD-9/10 codes) was associated with an increase in ACM (HR, 1.41; 95% CI, 1.16-1.72). Duration of diabetes, prior to CRPC diagnosis was inversely associated with PCSM among men identified by ICD-9/10 codes and/or HbA1c values (HR, 0.93; 95% CI, 0.88-0.98).
CONCLUSIONS
In men with late-stage prostate cancer, ICD-9/10 'code-identified' diabetes is associated with better overall survival than 'undiagnosed' diabetes identified by high HbA1c values only.
IMPACT
Our data suggest that better diabetes detection and management may improve survival in late-stage prostate cancer.
背景
患有晚期前列腺癌的糖尿病男性的预后情况尚不清楚，研究也相对较少。因此，我们研究了糖尿病与非转移性去势抵抗性前列腺癌（nmCRPC）患者转移、前列腺癌特异性死亡率（PCSM）和全因死亡率（ACM）进展之间的关系。
方法
使用 Cox 回归分析了 2000 年至 2017 年期间在 8 个退伍军人事务医疗保健中心诊断为 nmCRPC 的男性的数据，以确定糖尿病与结局之间的 HR 和 95%置信区间（CI）。根据以下标准对患有糖尿病的男性进行分类：（i）仅根据 ICD-9/10 代码，（ii）两次 HbA1c 值>6.4%（缺少 ICD-9/10 代码），以及（iii）所有糖尿病男性[（i）和（ii）组合]。
结果
在 976 名男性（中位年龄：76 岁）中，304 名（31%）在 nmCRPC 诊断时患有糖尿病，其中 51%有 ICD-9/10 代码。在中位随访 6.5 年期间，613 名男性被诊断为转移，482 名发生了 PCSM，741 名发生了 ACM 事件。在多变量调整模型中，根据 ICD-9/10 代码确定的糖尿病与 PCSM 呈负相关（HR，0.67；95%CI，0.48-0.92），而 HbA1c 值较高（无 ICD-9/10 代码）确定的糖尿病与 ACM 增加相关（HR，1.41；95%CI，1.16-1.72）。在根据 ICD-9/10 代码和/或 HbA1c 值确定的男性中，糖尿病的持续时间与 PCSM 呈负相关（HR，0.93；95%CI，0.88-0.98）。
结论
在晚期前列腺癌男性中，与仅根据 HbA1c 值较高确定的“未确诊”糖尿病相比，根据 ICD-9/10“代码确定”的糖尿病与总体生存情况更好相关。
影响
我们的数据表明，更好地检测和管理糖尿病可能会改善晚期前列腺癌患者的生存情况。
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