Background:This study evaluated the impact of diabetes mellitus (DM) and its treatments on cardiovascular outcomes in prostate cancer (PC) patients aged 66 years and older, with or without androgen deprivation therapy (ADT) exposure.Methods:Using the SEER-Medicare database (2009–2017), two cohorts were created: Cohort 1 included all PC patients enrolled in Medicare Parts A and B; Cohort 2 was a subset of Cohort 1 receiving ADT and enrolled in Medicare Part D. Exposures were DM and DM medications. Outcomes included cardiovascular events (CVEs), cardiovascular mortality (CVm), PC-specific mortality (PCsm), and all-cause mortality, analyzed using multivariable Fine-Gray and Cox models.Results:Cohort 1 included 150,647 PC patients (32% with DM, median age 72). DM was associated with higher risk of CVE (subdistribution hazard ratio [sHR] 1.20, 95% CI 1.17–1.22), CVm (sHR 1.35, 1.28–1.43), and all-cause mortality (adjusted HR [aHR] 1.22, 1.19–1.26) (allp< 0.001). Non-Hispanic Blacks (NHBs) and patients from lower socioeconomic (SES) and education areas experienced comparable or worse outcomes. In Cohort 2 (n= 14,938), DM patients on non-metformin therapies had higher all-cause mortality (aHR 1.33, 1.11–1.25;p= 0.002) than those on metformin, particularly in NHB and low education groups. Sensitivity analyses with follow-up limited to two years showed consistent results as overall.Conclusions:Diabetic PC patients, especially NHB, lower SES and lower education subgroups, were associated with worse cardiovascular and all-cause mortality outcomes. Metformin may be associated with better outcomes in these populations, warranting further research on the disparities in PC and diabetes, and cardioprotective effects of DM medications across different subpopulations.
背景：本研究评估了糖尿病及其治疗对66岁及以上前列腺癌患者心血管结局的影响，研究对象包括接受或未接受雄激素剥夺疗法的患者。 方法：利用SEER-Medicare数据库（2009-2017年）建立两个队列：队列1纳入所有参加Medicare A部分和B部分的前列腺癌患者；队列2为队列1中接受ADT治疗且参加Medicare D部分的患者亚组。暴露因素为糖尿病及降糖药物。结局指标包括心血管事件、心血管死亡率、前列腺癌特异性死亡率和全因死亡率，采用多变量Fine-Gray模型和Cox模型进行分析。 结果：队列1纳入150,647例前列腺癌患者（32%合并糖尿病，中位年龄72岁）。糖尿病与更高的心血管事件风险（次分布风险比[sHR] 1.20，95% CI 1.17-1.22）、心血管死亡率（sHR 1.35，1.28-1.43）和全因死亡率（校正风险比[aHR] 1.22，1.19-1.26）相关（所有p<0.001）。非西班牙裔黑人群体以及来自较低社会经济地位和低教育水平地区的患者具有相当或更差的结局。在队列2（n=14,938）中，接受非二甲双胍治疗的糖尿病患者比接受二甲双胍治疗者具有更高的全因死亡率（aHR 1.33，1.11-1.25；p=0.002），这一现象在非西班牙裔黑人和低教育水平群体中尤为明显。将随访时间限定为两年的敏感性分析显示结果与总体分析一致。 结论：合并糖尿病的前列腺癌患者，特别是非西班牙裔黑人、低社会经济地位和低教育水平亚组，其心血管结局和全因死亡率更差。二甲双胍可能改善这些人群的临床结局，这提示需要进一步研究前列腺癌与糖尿病共病的健康差异，以及降糖药物在不同亚群体中的心血管保护效应。
肿瘤(癌症)患者之家