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Type 2 diabetes and the risk of mortality among patients with prostate cancer

Abstract

Purpose

The aim of this study was to determine whether type 2 diabetes is associated with the incidence of prostate cancer mortality and all-cause mortality.

Methods

This study was conducted by linking four databases from the United Kingdom: the National Cancer Data Repository, the Clinical Practice Research Datalink, the Hospital Episodes Statistics database, and the Office for National Statistics database. The cohort consisted of men newly diagnosed with non-metastatic prostate cancer between 1 April 1998 and 31 December 2009, followed until 1 October 2012. Cox proportional hazard models were used to estimate adjusted hazard ratios with 95 % confidence intervals (CIs) of prostate cancer mortality and all-cause mortality comparing patients with to without type 2 diabetes. All models were adjusted for a number of potential confounders, which included excessive alcohol use, smoking, comorbidities, and prostate cancer-related variables.

Results

The cohort consisted of 11,920 patients, which included 1,132 (9.5 %) with preexisting type 2 diabetes. During a mean follow-up of 4.7 (SD 3.0) years, there were 3,605 deaths (incidence rate: 6.4 %/year) including 1,792 from prostate cancer (incidence rate: 3.3 %/year). Type 2 diabetes was associated with a 23 % increased risk of prostate cancer mortality (HR 1.23, 95 % CI 1.04–1.46) and a 25 % increased risk in all-cause mortality (HR 1.25, 95 % CI 1.11–1.40).

Conclusions

The results of this large population-based study indicate that type 2 diabetes is associated with an increased risk of prostate cancer mortality and all-cause mortality, which may signal an association between hyperinsulinemia or other diabetes-associated metabolic derangements and cancer aggressivity.

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Abbreviations

CPRD:

Clinical Practice Research Datalink

HES:

Hospital Episodes Statistics

ICD-10:

International Classification Of Diseases, 10th revision

NSAIDs:

Nonsteroidal anti-inflammatory drugs

ONS:

Office of National Statistics

OPCS-4:

Office of Population Censuses and Surveys classification of interventions and procedures, 4th version

PSA:

Prostate-specific antigen

UK:

United Kingdom

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Acknowledgments

L.B., S.S., and L.A. contributed to the study concept and design, to analysis and interpretation of data, to drafting of the manuscript, and to critical revision of the manuscript for important intellectual content. H.Y. and M.N.P. contributed to analysis and interpretation of data and to critical revision of the manuscript. L.A. supervised the study and is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. This research was not funded. Laurent Azoulay is the recipient of a Chercheur-Boursier Award from the Fonds de la recherche en santé du Québec, and Samy Suissa is the recipient of the James McGill Chair.

Conflict of interest

The authors declare that they have no conflicts of interest.

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Authors

Corresponding author

Correspondence to Laurent Azoulay.

Appendix

Appendix

See Tables 4, 5, 6, 7, and 8.

Table 4 Sensitivity analysis: type 2 diabetes and prostate cancer mortality censoring patients who developed type 2 diabetes in the non-diabetes group during follow-up
Table 5 Type 2 diabetes and the risk of non-prostate cancer mortality
Table 6 Effect measure modification by body mass index on the association between type 2 diabetes and mortality outcomes
Table 7 Effect measure modification by age on the association between type 2 diabetes and mortality
Table 8 Effect measure modification by Gleason score on the association between type 2 diabetes and mortality outcomes

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Bensimon, L., Yin, H., Suissa, S. et al. Type 2 diabetes and the risk of mortality among patients with prostate cancer. Cancer Causes Control 25, 329–338 (2014). https://doi.org/10.1007/s10552-013-0334-6

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  • DOI: https://doi.org/10.1007/s10552-013-0334-6

Keywords

  • Type 2 diabetes
  • Prostate cancer
  • Mortality
  • Hazard ratios