Cancer Epidemiology, University of Hawaii Cancer Center, 701 Ilalo Street, Honolulu, Hi, 96813, USA.
Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, USA.
Breast Cancer Res Treat. 2019 Feb;173(3):637-645. doi: 10.1007/s10549-018-5025-2. Epub 2018 Oct 26.
The purpose of the study was to investigate the association of type 2 diabetes (T2D) with survival of breast cancer (BC) patients across five ethnic groups within the Multiethnic Cohort study.
Between recruitment in 1993-1996 and 2013, 7570 incident BC cases were identified through SEER cancer registries in Hawaii and California. T2D diagnosed before BC was ascertained in 1013 women from self-reports and confirmed by administrative data sources. Covariate information was collected by questionnaire. Cox regression analysis with age as the time metric and BMI as time-varying exposure was applied to estimate hazard ratios (HR) and 95% confidence intervals (CI) for BC-specific and all-cause survival while adjusting for known prognostic factors.
In total, 2119 all-cause and 730 BC-specific deaths were recorded with corresponding 5-year survival rates of 86 and 93%. T2D was not a significant predictor of BC-specific survival (HR 0.84; 95% CI 0.65-1.09), but mortality was 36% lower for those with < 7 years of T2D than a longer history of T2D. On the other hand, all-cause mortality was higher in women with T2D (HR 1.23; 95% CI 1.08-1.40), especially in women with T2D of ≥ 7 years duration (HR 1.27; 95% CI 1.07-1.49). In women receiving none or either chemotherapy or radiation but not both, T2D predicted higher all-cause mortality (P = 0.004). Variations in the association of T2D with mortality across ethnic groups were small.
T2D was associated with higher all-cause but not BC-specific mortality among women with BC in the Multiethnic Cohort study. However, T2D affected survival in cases who did not receive both radiation and chemotherapy.
本研究旨在探讨 5 种族裔群体中，2 型糖尿病（T2D）与乳腺癌（BC）患者生存的相关性。
在 1993 年至 1996 年和 2013 年之间的招募期间，通过夏威夷和加利福尼亚州的 SEER 癌症登记处确定了 7570 例新确诊的 BC 病例。通过自我报告和行政数据来源确认了 1013 名女性的 T2D 诊断。通过问卷收集协变量信息。应用 Cox 回归分析，以年龄为时间度量，BMI 为时间变化的暴露因素，估计 BC 特异性和全因生存的危险比（HR）和 95%置信区间（CI），同时调整已知的预后因素。
共有 2119 例全因和 730 例 BC 特异性死亡，相应的 5 年生存率分别为 86%和 93%。T2D 不是 BC 特异性生存的显著预测因素（HR 0.84；95%CI 0.65-1.09），但与 T2D 病史较长的患者相比，T2D 病史<7 年的患者死亡率低 36%。另一方面，患有 T2D 的女性全因死亡率更高（HR 1.23；95%CI 1.08-1.40），尤其是 T2D 病史≥7 年的女性（HR 1.27；95%CI 1.07-1.49）。在未接受化疗、放疗或两者均未接受的女性中，T2D 预测全因死亡率更高（P=0.004）。T2D 与死亡率的相关性在不同族裔群体之间的差异较小。
在多民族队列研究中，患有 BC 的女性中，T2D 与全因但与 BC 特异性死亡率相关。然而，T2D 影响未接受放疗和化疗的患者的生存。
