Loktionova Marina V, Mohammadian Mahdi, Choopani Roya, Kheiri Soleiman, Mohammadian-Hafshejani Abdollah
I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.
MSc in Epidemiology, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran.
PLoS One. 2024 Dec 5;19(12):e0314565. doi: 10.1371/journal.pone.0314565. eCollection 2024.
The co-occurrence of breast cancer and diabetes presents complex clinical challenges, as each condition may influence the progression and management of the other, potentially worsening patient outcomes. This study aims to examine the association between insulin use and the risks of all-cause mortality, breast cancer-specific mortality, and recurrence in diabetic patients with breast cancer.
A systematic review and meta-analysis were conducted using studies identified from multiple databases, including Web of Science, Scopus, PubMed, Cochrane, Google Scholar, and Embase. The meta-analysis approach was used to estimate the relative risk (RR) of the relationship between insulin use and the risks of all-cause mortality, breast cancer-specific mortality, and recurrence in diabetic patients with breast cancer. Heterogeneity among studies was assessed using statistical tests such as the Chi-square test, I2, and forest plots. Meta-regression and sensitivity analyses were performed to explore sources of heterogeneity. The quality of the included studies was assessed using the Newcastle-Ottawa Scale checklist. Data were analyzed using Stata version 17 (Stata Corp, College Station, Texas).
Data from 22 studies conducted between 2002 and 2023, with a total of 159,674 participants, were analyzed. Nineteen studies were rated as high quality, and three as moderate quality. Diabetic patients with breast cancer who received insulin had a 1.65 (95% CI: 1.36-2.02; P < 0.001; I2 = 89.7%) times higher risk of overall mortality compared to those who did not use insulin. Meta-regression revealed that sample size and study quality were significant contributors to heterogeneity (P ≤ 0.10). Furthermore, insulin use was associated with a 1.22 (95% CI: 1.05-1.42; P = 0.009; I2 = 37.9%) times higher risk of breast cancer-specific mortality. For breast cancer recurrence, insulin use was associated with a 1.45 (95% CI: 1.19-1.77; P < 0.001; I2 = 3.4%) times higher risk. Sensitivity analysis confirmed the stability of the results across all outcomes.
This meta-analysis provides strong evidence that insulin use in diabetic patients with breast cancer is associated with increased risks of overall mortality, breast cancer-specific mortality, and recurrence. These findings underscore the need for careful consideration of insulin therapy in this patient population.
乳腺癌与糖尿病并存带来了复杂的临床挑战，因为每种疾病都可能影响另一种疾病的进展和管理，从而可能使患者预后恶化。本研究旨在探讨胰岛素使用与糖尿病合并乳腺癌患者的全因死亡率、乳腺癌特异性死亡率及复发风险之间的关联。
通过对多个数据库（包括科学网、Scopus、PubMed、Cochrane、谷歌学术和Embase）中检索到的研究进行系统综述和荟萃分析。采用荟萃分析方法估计胰岛素使用与糖尿病合并乳腺癌患者的全因死亡率、乳腺癌特异性死亡率及复发风险之间关系的相对风险（RR）。使用卡方检验、I²和森林图等统计检验评估研究间的异质性。进行荟萃回归和敏感性分析以探索异质性来源。使用纽卡斯尔-渥太华量表清单评估纳入研究的质量。使用Stata 17版本（Stata公司，德克萨斯州大学城）进行数据分析。
分析了2002年至2023年间开展的22项研究的数据，共有159,674名参与者。19项研究被评为高质量，3项为中等质量。与未使用胰岛素的糖尿病合并乳腺癌患者相比，使用胰岛素的患者全因死亡风险高1.65倍（95%置信区间：1.36 - 2.02；P < 0.001；I² = 89.7%）。荟萃回归显示样本量和研究质量是异质性的重要影响因素（P ≤ 0.10）。此外，胰岛素使用与乳腺癌特异性死亡风险高1.22倍（95%置信区间：1.05 - 1.42；P = 0.009；I² = 37.9%）相关。对于乳腺癌复发，胰岛素使用与风险高1.45倍（95%置信区间：1.19 - 1.77；P < 0.001；I² = 3.4%）相关。敏感性分析证实了所有结局结果的稳定性。
这项荟萃分析提供了有力证据，表明糖尿病合并乳腺癌患者使用胰岛素与全因死亡率、乳腺癌特异性死亡率及复发风险增加相关。这些发现强调了在这一患者群体中仔细考虑胰岛素治疗的必要性。
