伴2型糖尿病乳腺癌患者血糖水平对预后的影响

Effect of blood glucose level on the prognosis of breast cancer patients with type 2 diabetes mellitus

目的 探讨血糖水平对伴2型糖尿病乳腺癌患者预后的影响.方法 回顾性分析2005年1月至2009年12月天津医科大学肿瘤医院收治的416例伴2型糖尿病乳腺癌患者的临床资料,根据餐后2 h血糖水平的不同将患者分为＜11.1 mmol/L及≥11.1 mmol/L两组,比较两组患者临床病理学特征及生存情况.结果 416例患者中,餐后2 h血糖水平＜11.1 mmol/L 310例,≥11.1 mmol/L 106例.两组患者的临床病理学特征差异无统计学意义（均P＞0.05）.单因素分析结果显示,餐后2 h血糖＜11.1 mmol/L与≥11.1 mmol/L患者5年无病生存率、总生存率比较[81.6 %（253/310）比67.0 % （71/106）;87.7 %（272/310）比75.5 %（80/106）]差异均有统计学意义（χ2=8.575,P=0.003;χ2=8.722,P=0.003）.多因素分析结果显示餐后2 h血糖≥11.1 mmol/L是伴2型糖尿病乳腺癌患者5年无病生存率（HR=1.701,95 % CI 1.110～2.604, P=0.015）及5年总生存率（HR=1.972,95 % CI 1.186～3.279,P=0.009）的独立危险因素.结论 伴2型糖尿病血糖控制差的乳腺癌患者与其5年复发和死亡风险增加.应严格控制血糖水平,以改善伴2型糖尿病乳腺癌患者预后.

Objective To investigate the impact of blood glucose level on the prognosis of breast cancer patients with type 2 diabetes mellitus. Methods Clinical data of 416 breast cancer patients with type 2 diabetes mellitus in Tianjin Medical University Cancer Institute and Hospital from January 2005 to December 2009 were analyzed retrospectively. Patients were divided into 2 groups according to the postprandial 2 hours of blood glucose level （〈11.1 mmol/L and ≥11.1 mmol/L）. Clinicopathological characteristics and survival of the two groups were compared. Results There were 310 cases of postprandial 2 hours of blood glucose level （〈11.1 mmol/L）, and 106 cases of postprandial 2 hours of blood glucose level （≥11.1 mmol/L） in 416 patients. There was no statistical difference in the clinicopathological features between the two groups （both P〉 0.05）. Univariate analysis showed that the 5-year disease-free survival rate was 81.6 % （253/310） and 67.0 % （71/106） for patients with postprandial 2 hours of blood glucose level〈11.1 mmol/L and postprandial 2 hours of blood glucose level ≥11.1 mmol/L, respectively （χ2= 8.575, P=0.003）. The 5-year overall survival rate was 87.7 % （272/310） and 75.5 % （80/106） for patients with postprandial 2 hours of blood glucose level 〈11.1 mmol/L and postprandial 2 hours of blood glucose level≥11.1 mmol/L, respectively （χ2=8.722, P =0.003）. Multivariate analysis showed that 2 hours of blood glucose level≥11.1 mmol/L was an independent risk factor of 5-year disease-free survival rate （ HR=1.701, 95 % CI 1.110-2.604, P= 0.015） and 5-year overall survival rate （ HR= 1.972, 95 % CI 1.186-3.279, P= 0.009） for diabetic breast cancer patients. Conclusion The poor control of blood glucose level for the breast cancer patients complicated with type 2 diabetes is related with the increased risk of 5-year recurrence and death, which requires to strictly control the blood glucose level for improving the prognosis of type 2 diabetic breast cancer patients.