PO.PS01.06 · 人群科学

高危前列腺癌患者全因死亡率的临床和生活方式决定因素：一项多中心纵向队列研究（1990-2024）的发现

Clinical and lifestyle determinants of all-cause mortality among high-risk prostate cancer patients: Findings from a multicenter longitudinal cohort, 1990-2024

编号 5057 展板 30 时间 4/21 09:00–12:00 区域 Section 35 主讲 Cynthia Robbins, MS;PhD

分会场 Diet, Alcohol, and Tobacco, and Other Lifestyle Factors

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作者与单位 Authors & Affiliations

Cynthia R. Robbins¹, Jiji Jiang¹, Sally Elsamanoudi¹, Paul Campbell², Sean P. Stroup³, Jennifer Cullen⁴, Gregory Chesnut¹, Jongeun Rhee¹

¹Center for Prostate Disease Research (CDPR), Murtha Cancer Center Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD,²U.S. Naval Research Laboratory, Washington, DC,³Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD,⁴Houston Methodist Cancer Center, Houston, TX

摘要 Abstract

中文摘要

高危前列腺癌（PCa）患者的疾病进展和死亡风险大幅升高，但其结局仍高度可变。新出现的证据表明，合并症、肥胖和吸烟通过代谢和炎症途径促进PCa进展和总体生存。然而，很少有研究评估这些因素如何相互作用以影响高危PCa患者的死亡率。我们在一个大型纵向队列中考察了临床和生活方式因素对军队治疗机构内治疗的高危患者全因死亡率的个体和联合效应。纳入了来自前列腺疾病研究中心多中心国家数据库（1990-2024；n=2,713）的新诊断为美国国立综合癌症网络定义的高危PCa并接受根治性前列腺切除术（RP）、外照射放疗（EBRT）和雄激素剥夺治疗（ADT）的男性患者。进行多变量Cox回归分析以评估入组时生活方式因素（肥胖、吸烟）和自我报告的合并症状况与各治疗组全因死亡率之间的关联。诊断时中位年龄为68岁；66%自我认定为白人，26%为非裔美国人。总体而言，44%接受EBRT，34%接受RP，14%接受ADT。在随访期间，45%的患者死亡。慢性阻塞性肺疾病（COPD）是各治疗组全因死亡率升高的强预测因子[RP，风险比（HR）=1.98（1.13, 3.50）；EBRT，HR=1.52（1.09, 2.16）；ADT，HR=1.65（0.98, 2.75）]。该关联在RP组曾吸烟者中更为明显[HR=2.58 vs. 从不吸烟，HR=0.58]，以及在RP组[HR=2.21 vs. 肥胖，HR=1.27]和EBRT组[HR=1.80 vs. 1.01]的非肥胖患者中更为明显。高血压和糖尿病也与各治疗组较高的死亡率呈边缘性相关，在RP组曾吸烟者中关联更强[高血压，HR=1.58 vs. 0.77；糖尿病HR=1.6 vs. 0.49]。冠状动脉疾病是EBRT患者死亡率的显著预测因子[HR=1.34（1.03, 1.74）]，但在其他组中不是。肾功能不全与EBRT[HR=1.84（1.16, 2.93）]和ADT[HR=1.38（0.70, 2.73）]的死亡率升高相关，在从不吸烟者中关联更强[EBRT，HR=8.45 vs. 曾吸烟，HR=1.29]。COPD、高血压和糖尿病在高危PCa患者中一致地与全因死亡率升高相关，吸烟和肥胖状况存在适度的效应修饰。这些发现凸显了综合管理合并症和生活方式危险因素对改善这些高危患者生存的重要性。

查看英文原文 English abstract

Patients with high-risk prostate cancer (PCa) have substantially elevated risks of disease progression and mortality, yet outcomes remain highly variable. Emerging evidence suggests that comorbidities, obesity, and smoking contribute to PCa progression and overall survival through metabolic and inflammatory pathways. However, few studies have evaluated how these factors interact to influence mortality in high-risk PCa patients. We examined individual and combined effects of clinical and lifestyle factors on all-cause mortality in a large, longitudinal cohort of high-risk patients treated within military treatment facilities. Male patients with newly diagnosed National Comprehensive Cancer Network-defined high-risk PCa who underwent radical prostatectomy (RP), external beam radiation therapy (EBRT), and androgen deprivation therapy (ADT) were included from the Center for Prostate Disease Research Multicenter National Database (1990-2024; n=2,713). Multivariable Cox regression analyses were conducted to evaluate associations between lifestyle factors (obesity, smoking) and self-reported comorbidity conditions at enrollment and all-cause mortality across treatment groups. Median age at diagnosis was 68 years; 66% self-identified as White and 26% as African American. Overall, 44% underwent EBRT, 34% RP, and 14% ADT. During follow-up, 45% of patients died. Chronic obstructive pulmonary disease (COPD) was a strong predictor of increased all-cause mortality across all treatment groups [RP, Hazard Ratio (HR)=1.98 (1.13, 3.50); EBRT, HR=1.52 (1.09, 2.16); ADT, HR=1.65 (0.98, 2.75)]. The association was more apparent among ever smokers in RP group [HR=2.58 vs. never, HR=0.58] and among non-obese patients in RP [HR=2.21 vs. obese, HR=1.27] and EBRT [HR=1.80 vs. 1.01] groups. Hypertension and diabetes were also marginally associated with higher mortality across treatment groups, with stronger associations among ever smokers in RP [hypertension, HR=1.58 vs. 0.77; diabetes HR=1.6 vs. 0.49]. Coronary artery disease was a significant predictor of mortality among EBRT patients [HR=1.34 (1.03, 1.74)] but not in other groups. Renal insufficiency was associated with increased mortality in EBRT [HR=1.84 (1.16, 2.93)] and ADT [HR=1.38 (0.70, 2.73)], with a stronger association never smokers [EBRT, HR=8.45 vs. ever, HR=1.29]. COPD, hypertension, and diabethes were consistently associated with increased all-cause mortality in high-risk PCa patients, with modest effect modification by smoking and obesity status. These findings highlight the importance of integrated management of comorbidities and lifestyle risk factors to improve survivorship in this high-risk patients.

利益披露 Disclosure

C. R. Robbins, None.. J. Jiang, None.. S. Elsamanoudi, None.. P. Campbell, None.. S. P. Stroup, None.. J. Cullen, None.. G. Chesnut, None.. J. Rhee, None.

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