醋酸阿比特龙和恩杂鲁胺是转移性去势抵抗性前列腺癌 (mCRPC) 的两种常见疗法，已显示出可改善总生存期 (OS)。这些药物具有不同的作用机制，用于评估肥胖和糖尿病等合并症患者治疗效果的比较试验有限。这很重要，因为阿比特龙需要与泼尼松共同给药。我们评估了 mCRPC 中体重指数 (BMI)、糖化血红蛋白 (HbA1c)、治疗和生存之间的关系。2014 年 9 月 10 日至 2017 年 6 月 2 日期间，退伍军人健康管理局内接受阿比特龙或恩杂鲁胺治疗的退伍军人的 BMI 和 HbA1c被识别出来。其他变量包括年龄、首次治疗 mCRPC 时的基线前列腺特异性抗原、种族和查尔森合并症指数。使用 Kaplan-Meier 方法比较生存差异。使用 Cox 比例风险回归模型来评估初始治疗、BMI 和 HbA1c 之间的关联，同时调整混杂变量。总共确定了 5231 名患者，平均年龄为 75.2 岁，其中 1241 名 (23.7%) 为黑人种族。 BMI 与 OS 相关，BMI ≥ 30 (n = 1903) 的最长中位生存期为 29.8 个月，BMI 25-30 (n = 1879) 的最长中位生存期为 23.9 个月，BMI 18.5-25 (n = 1336) 的最长中位生存期为 15.9 个月，BMI 为 9.2 BMI < 18.5 的月份 (n = 113, p < 0.001)。在多变量模型中，与正常 BMI 相比，BMI< 18.5 时观察到死亡率增加（调整后风险比 (aHR) = 1.583，95% 置信区间 [CI]：1.29-1.94），BMI 25-30 (aHR) 时死亡率降低。 = 0.751, 95% CI: 0.69-0.81) 和 BMI > 30 (aHR = 0.644, 95% CI: 0.59-0.70)。在 3761 名 BMI≥25 的患者中，与阿比特龙治疗的患者 (25.8 个月，n = 2146，p= 0.002) 相比，恩杂鲁胺治疗的患者 (28.4 个月，n = 1615) 的 OS 更长。在 1470 名 BMI< 25 的患者中，接受恩杂鲁胺（16.0 个月，n = 597，p = 0.513）或阿比特龙（16.1 个月，n = 873）治疗的患者的 OS 没有差异。在 1333 名 HbA1c ≥6.5% 的退伍军人中，与阿比特龙相比，恩杂鲁胺的初始处方与更长的 OS 相关（24.4 个月与 20.5 个月，p= 0.0005）。在 2088 名 HbA1c< 6.5% 的患者中，最初服用恩杂鲁胺的患者与阿比特龙相比，OS 没有差异（25.7 个月与 23.5 个月，p= 0.334）。在患有 mCRPC 的退伍军人中，BMI 增加与更长的生存期相关。与阿比特龙相比，BMI≥25 的退伍军人使用恩杂鲁胺的生存期更长。在 HbA1c ≥6.5% 的患者中，与阿比特龙相比，恩杂鲁胺与更长的生存期相关。这些结果可能有助于生存预测并根据患者合并症改善治疗选择。© 2023 Wiley periodicals LLC。本文由美国政府雇员撰写，他们的作品在美国属于公共领域。

Abiraterone acetate and enzalutamide are two common therapies for metastatic castration-resistant prostate cancer (mCRPC) that have shown improved overall survival (OS). The drugs have different mechanisms of action with limited comparative trials to evaluate treatment in patients with comorbidities such as obesity and diabetes. This is important since abiraterone requires the co-administration of prednisone. We assessed the relationship between body mass index (BMI), hemoglobin A1c (HbA1c), treatment, and survival in mCRPC.Veterans treated with abiraterone or enzalutamide within the Veterans Health Administration between September 10, 2014 and June 2, 2017 with BMI and HbA1c were identified. Additional variables included age, baseline prostate-specific antigen at first treatment for mCRPC, race, and the Charlson comorbidity index. Differences in survival were compared using the Kaplan-Meier method. Cox proportional hazards regression modeling was used to assess the association between initial treatment, BMI, and HbA1c while adjusting for confounding variables.A total of 5231 patients were identified with a mean age of 75.2 years and 1241 (23.7%) were of black race. BMI was associated with OS with longest median survival of 29.8 months in BMI ≥ 30 (n = 1903), 23.9 months in BMI 25-30 (n = 1879), 15.9 months in BMI 18.5-25 (n = 1336), and 9.2 months in BMI < 18.5 (n = 113, p < 0.001). In a multivariable model compared to normal BMI, increased mortality was observed in BMI < 18.5 (adjusted hazard ratio (aHR) = 1.583, 95% confidence interval [CI]: 1.29-1.94) and a decreased mortality in BMI 25-30 (aHR = 0.751, 95% CI: 0.69-0.81) and BMI > 30 (aHR = 0.644, 95% CI: 0.59-0.70). In 3761 patients with BMI > 25, there was longer OS in patients treated with enzalutamide (28.4 months, n = 1615) compared to abiraterone (25.8 months, n = 2146, p = 0.002). In 1470 patients with BMI < 25, there was no difference in OS between patients treated with enzalutamide (16.0 months, n = 597, p = 0.513) or abiraterone (16.1 months, n = 873). In 1333 veterans with HbA1c ≥ 6.5%, initial prescription of enzalutamide was associated with longer OS compared with abiraterone (24.4 vs. 20.5 months, p = 0.0005). In 2088 patients with HbA1c < 6.5%, there was no difference in OS in patients who were initially prescribed enzalutamide versus abiraterone (25.7 vs. 23.5 months, p = 0.334).In veterans with mCRPC, increased BMI was associated with longer survival. Veterans with BMI > 25 had longer survival with enzalutamide compared to abiraterone. In patients with HbA1c ≥ 6.5%, enzalutamide was associated with longer survival compared to abiraterone. These results may facilitate prognostication of survival and improve treatment selection based on patient comorbidities.© 2023 Wiley Periodicals LLC. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.