Alan Ozkan, Akin Telli Tugba, Aktas Bilge, Koca Sinan, Ökten Ilker Nihat, Hasanov Rahib, Basoglu Tugba, Arikan Rukiye, Demircan Nazim Can, Ercelep Ozlem, Kaya Serap, Ugurlu Mustafa Umit, Kaya Handan, Akgul Babacan Nalan, Dane Faysal, Yumuk Perran Fulden
Division of Medical Oncology, Marmara University School of Medicine, Marmara University Pendik Education and Research Hospital, Fevzi Cakmak Mah, Muhsin Yazicioglu C, No 10, Ust Kaynarca, 34890, Istanbul, Turkey.
Division of Medical Oncology, Medeniyet University School of Medicine, Istanbul, Turkey.
World J Surg Oncol. 2020 Sep 9;18(1):242. doi: 10.1186/s12957-020-02019-y.
Neoadjuvant chemotherapy is the standard front-line treatment modality in locally advanced breast cancer. Achieving pathological complete response (pCR) is a significant prognostic factor for prolonged disease-free and overall survival. Insulin resistance is defined as a pathological condition in which insulin effect is impaired in peripheral target tissues such as the skeletal muscle, liver, and adipose tissue. The relationship between breast cancer and insulin resistance is controversial. In this study, our aim is to evaluate the role of insulin resistance, body mass index (BMI), metabolic syndrome, and inflammation markers to predict complete response in breast cancer patients who underwent neoadjuvant treatment.
Data from 55 locally advanced non-diabetic breast cancer patients, treated with neoadjuvant chemotherapy between 2015 and 2017, were retrospectively evaluated. Homeostatic model assessment, IR = insulin resistance (HOMA-IR) was calculated by using the obtained insulin and fasting blood glucose values before neoadjuvant chemotherapy (fasting insulin × fasting glucose/405). We considered a cut-off of 2.5 for insulin resistance. The systemic inflammatory index (SII), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) were calculated.
Twenty-five patients had no insulin resistance. The most common pathologic subtype (56%) was hormone receptor (HR) positive and human epidermal growth factor receptor-2 (Her-2)-negative invasive ductal carcinoma. Sixteen (29%) patients had a pathological complete response (pCR). We found that the probability of pCR in patients with insulin resistance was 4.7 times lower than that in patients without insulin resistance [OR: 4.7 (95%CI 1.7-17.2), p = 0.01].
Our results revealed that insulin resistance may have a negative effect on pathological complete response (pCR) following neoadjuvant therapy particularly with hormone-positive and Her-2-negative cases of non-diabetic breast cancer.
新辅助化疗是局部晚期乳腺癌的标准一线治疗方式。实现病理完全缓解（pCR）是延长无病生存期和总生存期的重要预后因素。胰岛素抵抗被定义为一种病理状态，即胰岛素在骨骼肌、肝脏和脂肪组织等外周靶组织中的作用受损。乳腺癌与胰岛素抵抗之间的关系存在争议。在本研究中，我们的目的是评估胰岛素抵抗、体重指数（BMI）、代谢综合征和炎症标志物在接受新辅助治疗的乳腺癌患者中预测完全缓解的作用。
回顾性评估了2015年至2017年间接受新辅助化疗的55例局部晚期非糖尿病乳腺癌患者的数据。通过新辅助化疗前获得的胰岛素和空腹血糖值计算稳态模型评估胰岛素抵抗（HOMA-IR），即胰岛素抵抗（HOMA-IR）=空腹胰岛素×空腹血糖/405。我们将胰岛素抵抗的临界值设定为2.5。计算全身炎症指数（SII）、中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR）。
25例患者无胰岛素抵抗。最常见的病理亚型（56%）是激素受体（HR）阳性且人表皮生长因子受体2（Her-2）阴性的浸润性导管癌。16例（29%）患者达到病理完全缓解（pCR）。我们发现，有胰岛素抵抗的患者达到pCR的概率比无胰岛素抵抗的患者低4.7倍[比值比：4.7（95%置信区间1.7-17.2），p=0.01]。
我们的结果显示，胰岛素抵抗可能对新辅助治疗后的病理完全缓解（pCR）产生负面影响，尤其是对于非糖尿病乳腺癌的激素阳性和Her-2阴性病例。
