Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China ; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China ; Department of Breast Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, Xinjiang, People's Republic of China.
Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China ; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.
Onco Targets Ther. 2014 Nov 27;7:2147-54. doi: 10.2147/OTT.S71095. eCollection 2014.
Type 2 diabetes mellitus (T2DM) is one of the most common chronic metabolic diseases. Increased cause-specific mortality and decreased disease-free survival (DFS) have been reported among cancer patients with T2DM compared with patients without T2DM, even after adjustments of other comorbidities. However, less is known about the impact of T2DM and other comorbidities on DFS in Chinese patients with early stage triple-negative breast cancer (TNBC).
We assessed patients who were newly diagnosed with early stage primary TNBC at the Department of Breast Surgery, Fudan University, from 2003 to 2011. Of the 1,100 TNBC patients, 865 female patients had invasive and early stage TNBC. The association of the variables in the T2DM and non-T2DM groups was compared using the Pearson's chi-square and independent t-tests. DFS was estimated using the Kaplan-Meier method. The effects of T2DM and other possible risk factors on DFS were assessed by Cox proportional hazards regression using univariate or multivariate analysis.
A total of 865 early stage primary TNBC cases were studied, including 104 (12.02%) subjects with T2DM. Metastatic or recurrent disease was detected in 24 (23.08%) patients in the T2DM group and 35 (4.60%) patients in the non-T2DM group. Patients with T2DM exhibited a significantly lower DFS than patients without T2DM (log-rank P<0.001). Similar results were observed when patients with positive lymph nodes were compared with patients with negative lymph nodes (log-rank P=0.003). T2DM was independently associated with a lower DFS after adjustments of other variables (adjusted hazard ratio, 7.719; 95% confidence interval, 4.304-13.843; P<0.001) and adjustments of lymph node positivity (adjusted hazard ratio, 2.407; 95% confidence interval, 1.391-4.166; P=0.002). The DFS rates at 2 years for the T2DM group and the non-T2DM group were 78% and 97%, respectively. The prognostic influence of T2DM was consistent across the subgroups, including subgroups by age (>50 or ≤50), menopausal status (post- or premenopausal), tumor size (>5 cm or ≤5 cm), lymph node involvement (positive or negative), and adjuvant chemotherapy (received or not) using the Kaplan-Meier method (log-rank P<0.05).
In the People's Republic of China, T2DM is an independent prognostic risk factor that indicates an increased likelihood of recurrence and metastasis in patients with early stage TNBC. The presence of T2DM should be taken into account when evaluating the risk for an early stage TNBC patient. More effective therapeutic regimens are needed for early stage TNBC patients with T2DM.
2 型糖尿病（T2DM）是最常见的慢性代谢性疾病之一。与无 T2DM 的癌症患者相比，T2DM 患者的特定原因死亡率增加，无病生存期（DFS）降低，即使在调整了其他合并症后也是如此。然而，在中国早期三阴性乳腺癌（TNBC）患者中，T2DM 及其他合并症对 DFS 的影响知之甚少。
我们评估了 2003 年至 2011 年在复旦大学乳腺外科新诊断为早期原发性 TNBC 的患者。在 1100 例 TNBC 患者中，865 例女性患者患有浸润性和早期 TNBC。使用 Pearson 卡方检验和独立 t 检验比较 T2DM 组和非 T2DM 组中变量的相关性。使用 Kaplan-Meier 法估计 DFS。使用单变量或多变量分析，通过 Cox 比例风险回归评估 T2DM 和其他可能的危险因素对 DFS 的影响。
共研究了 865 例早期原发性 TNBC 病例，其中 104 例（12.02%）患者患有 T2DM。T2DM 组中有 24 例（23.08%）患者出现转移性或复发性疾病，非 T2DM 组中有 35 例（4.60%）患者出现。与无 T2DM 的患者相比，患有 T2DM 的患者 DFS 明显降低（log-rank P<0.001）。当比较淋巴结阳性患者与淋巴结阴性患者时，也观察到了类似的结果（log-rank P=0.003）。在调整其他变量后，T2DM 与较低的 DFS 独立相关（调整后的危险比，7.719；95%置信区间，4.304-13.843；P<0.001）和调整淋巴结阳性（调整后的危险比，2.407；95%置信区间，1.391-4.166；P=0.002）。T2DM 组和非 T2DM 组的 2 年 DFS 率分别为 78%和 97%。T2DM 的预后影响在各亚组中是一致的，包括年龄（>50 岁或≤50 岁）、绝经状态（绝经后或绝经前）、肿瘤大小（>5 cm 或≤5 cm）、淋巴结受累（阳性或阴性）和辅助化疗（接受或不接受），使用 Kaplan-Meier 法（log-rank P<0.05）。
在中国，T2DM 是一个独立的预后危险因素，表明早期 TNBC 患者复发和转移的可能性增加。在评估早期 TNBC 患者的风险时，应考虑 T2DM 的存在。对于患有 T2DM 的早期 TNBC 患者，需要更有效的治疗方案。
