口服降糖药物与胰岛素对乳腺癌合并2型糖尿病患者病理特征及预后的影响

Effect of Oral Hypoglycemic Drugs and Insulin on Pathological Characteristics and Prognosis of Patients with Breast Cancer Complicated with Type 2 Diabetes Mellitus

目的:分析口服降糖药与胰岛素对乳腺癌合并2型糖尿病(T2DM)患者病理特征及预后的影响。方法:选取2017年1月—2018年6月吉林大学中日联谊医院乳腺外科收治的225例乳腺癌患者作为研究对象,其中不合并T2MD的患者共150例,纳入非糖尿病组;合并T2DM的75例患者纳入糖尿病组。75例合并T2DM的患者中,使用胰岛素控制血糖49例,口服降糖药物控制血糖26例,分别纳入胰岛素疗法组与口服降糖药疗法组。比较患者临床病理特征及预后。结果:糖尿病组患者年龄、体重指数均高于非糖尿病组,差异有统计学意义(P<0.001)。糖尿病组肿瘤直径大于非糖尿病组,雌激素受体(ER)阳性率低于非糖尿病组,组织学分级Ⅲ级占比、淋巴结转移≥N1占比、死亡率均高于非糖尿病组,差异有统计学意义(P<0.05);两组人表皮生长因子受体-2(Her-2)、肿瘤增殖指数(Ki-67)比较,差异无统计学意义(P>0.05)。胰岛素疗法组原发肿瘤直径≥T2占比以及复发/死亡率高于口服降糖药疗法组,差异有统计学意义(P<0.05);两组ER、Her-2、组织学分级、淋巴结转移、Ki-67情况比较,差异无统计学意义(P>0.05)。结论:使用胰岛素是影响乳腺癌患者预后的不利因素,二甲双胍可改善乳腺癌合并T2DM患者预后。

Objective:To analyze the effect of oral hypoglycemic drugs and insulin on pathological characteristics and prognosis of breast cancer patients with type 2 diabetes mellitus(T2MD).Methods:A total of 225 breast cancer patients treated in the Department of Breast Surgery of China-Japan Union Hospital of Jilin University from January 2017 to June 2018 were selected as the study subjects.Among them,150 patients without T2MD were included in the non-diabetes group;75 patients with T2DM were included in the diabetes group.Among the 75 patients with T2DM,49 cases used insulin to control blood glucose,and 26 cases used oral hypoglycemic drugs to control blood glucose,they were included in the insulin therapy group and oral hypoglycemic drug therapy group,respectively.The clinicopathological characteristics and prognosis of the patients were compared.Results:The age and body mass index in the diabetes group were higher than those in the non-diabetes group,and the difference was statistically significant(P<0.001).The tumor diameter in the diabetes group was larger than that in the nondiabetes group,the positive rate of estrogen receptor(ER)in the diabetes group was lower than that in the non-diabetes group,the proportion of gradeⅢby histological grade,the proportion of lymph node metastasis≥N1 and the mortality rate in the diabetes group were higher than those in the non-diabetes group,and the differences were statistically significant(P<0.05).There was no significant difference in human epidermal growth factor receptor-2(Her-2)and tumor proliferation index(Ki-67)between the two groups(P>0.05).The proportion of primary tumor diameter≥T2 and the recurrence/mortality rate in insulin therapy group were higher than those in oral hypoglycemic drug therapy group,and the difference was statistically significant(P<0.05).There was no significant difference in ER,Her-2,histological grade,lymph node metastasis and Ki-67 between the two groups(P>0.05).Conclusion:Insulin use is an adverse factor affecting the prognosis of patients with breast cancer,and metformin can improve the prognosis of patients with breast cancer complicated with T2DM.