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Zaorsky NG , Shaikh T , Ruth K , Sharda P , Hayes SB , Sobczak ML , Hallman MA , Smaldone MC , Chen DY , Horwitz EM
Prostate Cancer Patients With Unmanaged Diabetes or Receiving Insulin Experience Inferior Outcomes and Toxicities After Treatment With Radiation Therapy
Clin Genitourin Cancer. 2017 Apr;15(2) :326-335 e3
PMID: 27789181    PMCID: PMC7592603    URL: https://www.ncbi.nlm.nih.gov/pubmed/27789181
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Abstract
BACKGROUND: The purpose of the study was to determine the effect of type 2 diabetes mellitus (T2DM) on outcomes and toxicities among men with localized prostate cancer receiving definitive radiation therapy. PATIENTS AND METHODS: We performed a retrospective review of 3217 patients, from 1998 to 2013, subdivided into 5 subgroups: (I) no T2DM; (II) T2DM receiving oral antihyperglycemic agent that contains metformin, no insulin; (III) T2DM receiving nonmetformin oral agent alone, no insulin; (IV) T2DM receiving any insulin; and (V) T2DM not receiving medication. Outcome measures were overall survival, freedom from biochemical failure (BF), freedom from distant metastasis, cancer-specific survival, and toxicities. Kaplan-Meier analysis, log rank tests, Fine and Gray competing risk regression (to adjust for patient and lifestyle factors), Cox models, and subdistribution hazard ratios (sHRs) were used. RESULTS: Of the 3217 patients, 1295 (40%) were low-risk, 1192 (37%) were intermediate-risk, and 652 (20%) were high risk. The group I to V distribution was 81%, 8%, 5%, 3%, and 4%. The median dose was 78 Gy, and the median follow-up time was 50 (range, 1-190) months. Group V had increased mortality (sHR, 2.1; 95% confidence interval [CI], 0.66-1.54), BF (sHR, 2.14; 0.88-1.83), and cause-specific mortality (sHR, 3.87; 95% CI, 1.31-11). Acute toxicities were higher in group IV versus group I (genitourinary: 38% vs. 26%; P = .01; gastrointestinal: 21% vs. 5%; P = 001). Late toxicities were higher in groups IV and V versus group I (12%-14% vs. 2%-6%; P < .01). CONCLUSION: Men with T2DM not receiving medication and men with T2DM receiving insulin had worse outcomes and toxicities compared to other patients.
Notes
1938-0682 Zaorsky, Nicholas G Shaikh, Talha Ruth, Karen Sharda, Pankaj Hayes, Shelly B Sobczak, Mark L Hallman, Mark A Smaldone, Marc C Chen, David Y T Horwitz, Eric M P30 CA006927/CA/NCI NIH HHS/ Journal Article United States Clin Genitourin Cancer. 2016 Sep 8. pii: S1558-7673(16)30254-3. doi: 10.1016/j.clgc.2016.08.020.