2型糖尿病及二甲双胍治疗对乳腺癌患者预后的影响

The effect of type 2 diabetes mellitus and metformin treatment on the prognosis of breast cancer patients

目的探讨2型糖尿病与乳腺癌的关系,以及二甲双胍治疗对2型糖尿病合并乳腺癌患者预后的影响。方法收集河北省人民医院自2014年1月到2015年12月之间乳腺癌合并2型糖尿病患者102例为2型糖尿病组,选取同时期就诊的乳腺癌非糖尿病患者106例为对照组,其中2型糖尿病组按治疗方案中是否使用二甲双胍分为二甲双胍组和非二甲双胍组进行亚组分组。比较两组的一般资料、临床分期、肿瘤组织学分级、分子分型及预后,生存曲线分析二甲双胍治疗对预后的影响。结果2型糖尿病组较对照组的乳腺癌患者年龄更大,绝经后患者比例更高,均有统计学意义(P<0.05),但两组体质量、家族史无统计学差异(P>0.05);2型糖尿病组与对照组比较临床分期更晚、组织学分级更高,分子分型Basal-like分型者更常见,均有统计学意义(P<0.05);2型糖尿病组与对照组比较患者的局部复发、淋巴结及远处转移比例高,但无统计学意义(P>0.05),2型糖尿病组患者的5年生存率比对照组低,差异有统计学意义(P<0.05)。二甲双胍组与非二甲双胍组比较一般情况、临床分期、组织学分级、分子分型无统计学差异(P>0.05),二甲双胍治疗后较非二甲双胍组局部复发和远处转移发生情况差异无统计学意义(P>0.05),二甲双胍组总生存率及去除其他死亡原因生存率高(P<0.05)。结论2型糖尿病可能是影响乳腺癌发生发展及预后的危险因素之一,降低乳腺癌患者5年生存率,在绝经后妇女中尤为显著,使用二甲双胍治疗能改善2型糖尿病合并乳腺癌患者的生存情况,改善其预后。

Objective To explore the relationship between type 2 diabetes and breast cancer,and the effect of metformin treatment on the prognosis of breast cancer patients with type 2 diabetes.Methods 102 breast cancer patients with type 2 diabetes were enrolled into this study in our hospital from January 2014 to December 2015 as the type 2 diabetes group,and 106 breast cancer patients without type 2 diabetes in the same period as the control group.The type 2 diabetes group was divided into metformin group and non-metformin group according to the treatment plan using metformin for sub-group.The general information,clinical stage,histological grade,molecular classification and prognosis were compared.The survival curve was used to analyze the effect of metformin treatment on the prognosis.Results Compared with the control group,the breast cancer patients in the type 2 diabetes group were older,and the proportion of postmenopausal patients was higher,both were statistically significant(P<0.05),but there was no statistical difference in body weight and family history between the two groups(P>0.05);Compared with the control group,the type 2 diabetes group has a later clinical stage and a higher histological grade,and the molecular type Basal-like type is more common,these are statistically significant(P<0.05);The type 2 diabetes group compared with the control group,the proportion of patients with local recurrence,lymph node and distant metastasis was higher,but it was not statistically significant(P>0.05).The 5-year survival rate of patients in the type 2 diabetes group was lower than that of the control group,and the difference was statistically significant(P<0.05).There was no statistically significant difference between the metformin group and the non-metformin group in general conditions,clinical stage,histological grade,and molecular typing(P>0.05).There was no significant difference in the occurrence of local recurrence and distant metastasis after metformin treatment compared with the non-metformin group(P>0.05),and the overall survival rate and survival rate removing other causes of death in the metformin group were higher(P<0.05).Conclusion Type 2 diabetes may be one of the risk factors affecting the development and prognosis of breast cancer.It reduces the 5-year survival rate of breast cancer patients,especially in postmenopausal women.The use of metformin can improve the survival of patients with type 2 diabetes and breast cancer and improve the prognosis.