糖尿病对乳腺癌手术和放疗的影响。
Impact of diabetes on surgery and radiotherapy for breast cancer.
机构信息
Medical Research Centre, The University of Waikato, Hamilton, New Zealand.
Strategy and Funding, Waikato Hospital, Hamilton, New Zealand.
出版信息
Breast Cancer Res Treat. 2023 Jun;199(2):305-314. doi: 10.1007/s10549-023-06915-1. Epub 2023 Mar 30.
PURPOSES
This study aims to examine whether diabetes has an impact on the use of surgery and adjuvant radiotherapy in treating women with localised breast cancer.
METHODS
Women diagnosed with stage I-III breast cancer between 2005 and 2020 were identified from Te Rēhita Mate Ūtaetae-Breast Cancer Foundation New Zealand National Register, with diabetes status determined using New Zealand's Virtual Diabetes Register. The cancer treatments examined included breast conserving surgery (BCS), mastectomy, breast reconstruction after mastectomy, and adjuvant radiotherapy after BCS. Logistic regression modelling was used to estimate the adjusted odds ratio (OR) and 95% confidence interval (95% CI) of having cancer treatment and treatment delay (> 31 days) for patients with diabetes at the time of cancer diagnosis compared to patients without diabetes.
RESULTS
We identified 25,557 women diagnosed with stage I-III breast cancer in 2005-2020, including 2906 (11.4%) with diabetes. After adjustment for other factors, there was no significant difference overall in risk of women with diabetes having no surgery (OR 1.12, 95% CI 0.94-1.33), although for patients with stage I disease not having surgery was more likely (OR 1.45, 95% CI 1.05-2.00) in the diabetes group. Patients with diabetes were more likely to have their surgery delayed (adjusted OR of 1.16, 95% CI 1.05-1.27) and less likely to have reconstruction after mastectomy compared to the non-diabetes group-adjusted OR 0.54 (95% CI 0.35-0.84) for stage I cancer, 0.50 (95% CI 0.34-0.75) for stage II and 0.48 (95% CI 0.24-1.00) for stage III cancer.
CONCLUSIONS
Diabetes is associated with a lower likelihood of receiving surgery and a greater delay to surgery. Women with diabetes are also less likely to have breast reconstruction after mastectomy. These differences need to be taken in to account when considering factors that may impact on the outcomes of women with diabetes especially for Māori, Pacific and Asian women.
目的
本研究旨在探讨糖尿病是否会影响局部乳腺癌女性患者的手术和辅助放疗的应用。
方法
从新西兰乳腺癌基金会国家登记处的 Te Rēhita Mate Ūtaetae-Breast Cancer Foundation New Zealand National Register 中确定了 2005 年至 2020 年间被诊断为 I 期至 III 期乳腺癌的女性患者，并使用新西兰虚拟糖尿病登记处确定了糖尿病的状态。研究考察的癌症治疗包括保乳手术 (BCS)、乳房切除术、乳房切除术的乳房重建以及 BCS 后的辅助放疗。使用逻辑回归模型估计了诊断时患有糖尿病的患者与未患有糖尿病的患者相比，接受癌症治疗和治疗延迟（>31 天）的调整后比值比 (OR) 和 95%置信区间 (95%CI)。
结果
我们确定了 2005 年至 2020 年间诊断为 I 期至 III 期乳腺癌的 25557 名女性患者，其中 2906 名（11.4%）患有糖尿病。在调整了其他因素后，总体上患有糖尿病的女性患者无手术的风险无显著差异（OR 1.12，95%CI 0.94-1.33），尽管患有 I 期疾病的患者无手术的可能性更高（OR 1.45，95%CI 1.05-2.00）。与非糖尿病组相比，糖尿病患者的手术更有可能延迟（调整后的 OR 为 1.16，95%CI 1.05-1.27），并且乳房切除术之后进行重建的可能性更小-调整后的 OR 为 I 期癌症 0.54（95%CI 0.35-0.84），II 期 0.50（95%CI 0.34-0.75）和 III 期 0.48（95%CI 0.24-1.00）。
结论
糖尿病与接受手术的可能性降低以及手术延迟有关。患有糖尿病的女性患者乳房切除术之后进行重建的可能性也更小。在考虑可能影响糖尿病女性患者结果的因素时，特别是对毛利人、太平洋岛民和亚裔女性时，需要考虑这些差异。
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