Kim Hee Jeong, Kwon Hyunwook, Lee Jong Won, Kim Hwa Jung, Lee Sae Byul, Park Hee Sung, Sohn Guiyun, Lee Yura, Koh Beom Seok, Yu Jong Han, Son Byung Ho, Ahn Sei Hyun
Division of Breast and Endocrine Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Division of Vascular Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Breast Cancer Res. 2015 May 3;17(1):64. doi: 10.1186/s13058-015-0574-3.
Metformin use has recently been observed to decrease both the rate and mortality of breast cancer. Our study was aim to determine whether metformin use is associated with survival in diabetic breast cancer patients by breast cancer subtype and systemic treatment.
Data from the Asan Medical Center Breast Cancer Database from 1997 to 2007 were analyzed. The study cohort comprised 6,967 nondiabetic patients, 202 diabetic patients treated with metformin, and 184 diabetic patients that did not receive metformin. Patients who were divided into three groups by diabetes status and metformin use were also divided into four subgroups by hormone receptor and HER2-neu status.
In Kaplan-Meier analysis, the metformin group had a significantly better overall and cancer specific survival outcome compared with non metformin diabetic group (P <0.005 for both). There was no difference in survival between the nondiabetic and metformin groups. In multivariate analysis, Compared with metformin group, patients who did not receive metformin tended to have a higher risk of metastasis with HR 5.37 (95 % CI, 1.88 to 15.28) and breast cancer death with HR 6.51 (95 % CI, 1.88 to 15.28) on the hormone receptor-positive and HER2-negative breast cancer. The significant survival benefit of metformin observed in diabetic patients who received chemotherapy and endocrine therapy (HR for disease free survival 2.14; 95 % CI 1.14 to 4.04) was not seen in diabetic patients who did not receive these treatments.
Patients receiving metformin treatment when breast cancer diagnosis show a better prognosis only if they have hormone receptor-positive, HER2-positive tumors. Metformin treatment might provide a survival benefit when added to systemic therapy in diabetic patients.
最近观察到使用二甲双胍可降低乳腺癌的发病率和死亡率。我们的研究旨在确定使用二甲双胍是否与糖尿病乳腺癌患者按乳腺癌亚型和全身治疗的生存率相关。
分析了1997年至2007年峨山医学中心乳腺癌数据库的数据。研究队列包括6967名非糖尿病患者、202名接受二甲双胍治疗的糖尿病患者和184名未接受二甲双胍治疗的糖尿病患者。按糖尿病状态和二甲双胍使用情况分为三组的患者，也按激素受体和HER2- neu状态分为四个亚组。
在Kaplan-Meier分析中，与未使用二甲双胍的糖尿病组相比，二甲双胍组的总体生存率和癌症特异性生存结果显著更好（两者P均<0.005）。非糖尿病组和二甲双胍组之间的生存率无差异。在多变量分析中，与二甲双胍组相比，未接受二甲双胍治疗的患者在激素受体阳性和HER2阴性乳腺癌中发生转移的风险更高，风险比（HR）为5.37（95%可信区间，1.88至15.28），乳腺癌死亡风险比为6.51（95%可信区间，1.88至15.28）。在接受化疗和内分泌治疗的糖尿病患者中观察到的二甲双胍显著生存获益（无病生存的HR为2.14；95%可信区间1.14至4.04）在未接受这些治疗的糖尿病患者中未观察到。
乳腺癌诊断时接受二甲双胍治疗的患者，仅在其肿瘤为激素受体阳性、HER2阳性时预后较好。二甲双胍治疗添加到糖尿病患者的全身治疗中可能会带来生存获益。
