Supplementary Material for: Prognostic impact of coronary calcifications in patients with recently diagnosed prostate cancer

Background. Patients with prostate cancer are at increased risk of cardiovascular events. A non-electrocardiogram gated CT scan of the thorax is part of the diagnostic workup, allowing for assessment of coronary calcifications. However, the prognostic impact of a coronary artery calcium score (CACS) obtained from such CT scans is uncertain.
Objectives. To investigate the association between CACS and a combined endpoint of all-cause death, myocardial infarction, or stroke in patients with recently diagnosed prostate cancer.
Methods. The primary analysis included patients (N=571) with recently diagnosed prostate cancer and without known coronary artery disease undergoing prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT). Patients were stratified into four CACS groups. Cox proportional hazard models adjusted for risk factors were used to examine the association between CACS and the combined endpoint.
Results. Patients were distributed in the four CACS groups as follows: CACS 0-10 (26%), 11-99 (21%), 100-399 (24%) and ≥400 (29%). An increased risk of the combined endpoint was found with increasing CACS. Compared with CACS 0-10, the hazard ratios for CACS 11-99, 100-399 and ≥400 were 0.95 (95% CI: 0.37-2.42), 2.39 (95% CI: 1.13-5.09) and 3.14 (95% CI: 1.52-6.48), respectively. Only 53% of patients in the CACS ≥400 group received statins.
Conclusion. In patients with prostate cancer, assessment of a CACS from the initial PET/CT scan allows for the identification of patients with a threefold higher risk of death, myocardial infarction, or stroke. Initiation of preventive statin treatment in these patients could reduce cardiovascular events.

背景：前列腺癌患者发生心血管事件的风险显著升高。胸部非心电图门控CT扫描是其诊断评估流程的组成部分，可用于评估冠状动脉钙化情况。然而，通过此类CT扫描获得的冠状动脉钙化评分（coronary artery calcium score, CACS）的预后价值尚不明确。
研究目的：探讨近期确诊的前列腺癌患者中，CACS与全因死亡、心肌梗死或卒中的复合终点之间的关联。
方法：本研究的主要分析纳入了571例近期确诊前列腺癌、无已知冠状动脉疾病且接受前列腺特异性膜抗原正电子发射断层扫描/计算机断层扫描（PSMA PET/CT）的患者。将患者按CACS水平分为四组。采用校正了传统危险因素的Cox比例风险模型，分析CACS与该复合终点之间的关联。
结果：患者在四组CACS中的分布情况如下：CACS 0~10组占26%，11~99组占21%，100~399组占24%，≥400组占29%。随着CACS水平升高，复合终点的发生风险逐步升高。与CACS 0~10组相比，CACS 11~99、100~399及≥400组的风险比分别为0.95（95%置信区间：0.37~2.42）、2.39（95%置信区间：1.13~5.09）及3.14（95%置信区间：1.52~6.48）。仅53%的CACS≥400组患者接受了他汀类药物治疗。
结论：在前列腺癌患者中，通过初始PSMA PET/CT扫描评估CACS，可识别出死亡、心肌梗死或卒中风险较基线升高3倍的人群。对此类患者启动预防性他汀类药物治疗，或可降低其心血管事件的发生风险。