乳腺癌合并2型糖尿病的临床病理特征及新辅助化疗疗效分析

Clinicopathologic features and the efficacy of neoadjuvant chemotherapy in breast cancer with type 2 diabetes mellitus

目的探讨分析乳腺癌合并2型糖尿病(T2DM)患者的临床病理特征及其新辅助化疗疗效。方法选取2013年1月至2019年12月湖北医药学院附属太和医院甲乳外科行新辅助化疗的375例乳腺癌患者,其中乳腺癌合并T2DM 101例(观察组),单纯乳腺癌274例(对照组)。对两组患者临床病理资料、新辅助化疗疗效及预后情况进行分析。结果与对照组比较,观察组年龄大、绝经后女性多见、组织学分级高(均P<0.05),完成化疗的周期数少于对照组(P<0.05)。两组患者病理类型、临床分期、腋窝淋巴结状态和分子分型的比较上均无统计学差异(均P>0.05)。观察组在FPG、胰岛素水平、糖化血红蛋白均明显高于对照组(均P<0.05)。观察组中新辅助化疗的有效率为68.3%,低于对照组的82.5%(P<0.05),同时观察组中血糖控制不佳组的新辅助化疗有效率为60.0%,低于血糖控制佳组的83.3%(P<0.05)。观察组在无病生存率和总生存率上均低于对照组(均P<0.05)。结论乳腺癌合并T2DM患者年龄大,以绝经后女性患者多见,组织学分级高,新辅助化疗疗效差。血糖控制不佳可能是导致T2DM乳腺癌患者新辅助化疗效果和预后差的重要原因。

Objective To investigate clinicopathologic features and efficacy of neoadjuvant chemotherapy in breast cancer patients with type 2 diabetes mellitus(T2DM).Methods From January 2013 to December 2019,a total of 375 patients who underwent neoadjuvant chemotherapy in the Breast and Thyroid Surgery Department of Taihe Hospital were enrolled in the study,including 101 patients with T2DM(study group)and 274 patients with no T2DM(control group).The clinicopathologic features,neoadjuvant chemotherapy efficacy and prognosis were analyzed in the two groups.Results Compared with the control group,the study group had older age,more postmenopausal patients,higher histological grade(all P<0.05),and fewer cycles of chemotherapy cycle(P<0.05).There was no significant difference in pathological type,clinical stage,axillary lymph node status and molecular subtypes between the two groups(all P>0.05).The fasting blood glucose,insulin level and glycated hemoglobin in the study group were significantly higher than those in the control group(all P<0.05).The effective rate of neoadjuvant chemotherapy in the study group was lower than that in the control group(68.3%vs.82.5%,P<0.05).Meanwhile the effective rate of neoadjuvant chemotherapy in T2DM patients with hyperglycemia was lower than T2DM patients with controlled blood glucose(60%vs.83.3%,P<0.05).The disease free survival and over survival rates of study group were lower than that of the control group(all P<0.05).Conclusion Breast cancer patients with T2DM are likely to be older,more common in postmenopausal period and high histological grade,and their efficacy of neoadjuvant chemotherapy was poorer.Hyperglycemia may be an important cause of poor efficacy of neoadjuvant chemotherapy and poor prognosis in breast cancer patients with T2DM.