Impact of Poor Glycemic Control upon Clinical Outcomes after Radical Prostatectomy in Localized Prostate Cancer
Abstract To evaluate the clinical impact of preoperative glycemic status upon oncological and functional outcomes after radical prostatectomy in patients with localized prostate cancer, we analyzed the data of 2,664 subjects who underwent radical prostatectomy with preoperative measurement of hemoglobin A1c within six months before surgery. The possible association between high hemoglobin A1c (≥ 6.5 ng/dL) and oncological/functional outcomes was evaluated. Among all subjects, 449 (16.9%) were categorized as the high hemoglobin A1c group and 2,215 (83.1%) as the low hemoglobin A1c group. High hemoglobin A1c was associated with worse pathological outcomes including extra-capsular extension (HR 1.277, 95% CI 1.000–1.630, p = 0.050) and positive surgical margin (HR 1.302, 95% CI 1.012–1.674, p = 0.040) in multi-variate regression tests. Kaplan-Meier analysis showed statistically longer biochemical recurrence-free survival in the low hemoglobin A1c group (p < 0.001), and subsequent multivariate Cox proportional analyses revealed that high hemoglobin A1c is an independent predictor for longer BCR-free survival (HR 1.135, 95% CI 1.016–1.267, p = 0.024). Moreover, the low hemoglobin A1c group showed a significantly shorter urinary continence-free survival than the low hemoglobin A1c group (p = 0.001), and preoperative hemoglobin A1c was also an independent predictor for continence-free survival in multivariate Cox analyses (HR 0.929, 95% CI 0.879–0.981, p = 0.008). The high preoperative hemoglobin A1c level was independently associated with worse oncological outcomes and also with inferior recovery of urinary continence after radical prostatectomy.