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利用常规收集的患者数据研究2型糖尿病对乳腺癌的影响。

Using routinely collected patient data to study the impact of type 2 diabetes on breast cancer.

作者信息

Khurshed Ayaan, Hernandez Gema, Soady Gavin, Joharatnam-Hogan Nalinie, Morganstein Daniel

机构信息

Beta Cell Diabetes Unit, Chelsea and Westminster NHS Foundation Trust, London, UK.

TriNetX, Cambridge, Massachusetts, USA.

出版信息

Endocr Oncol. 2025 Jul 8;5(1):e240039. doi: 10.1530/EO-24-0039. eCollection 2025 Jan.

DOI:10.1530/EO-24-0039
PMID:40641630
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12243097/
Abstract

OBJECTIVE

Type 2 diabetes mellitus (T2DM) and cancer are prevalent conditions, with evidence linking T2DM to higher breast cancer incidence and mortality. However, it is uncertain whether excess mortality in breast cancer patients with diabetes is driven by cancer-related factors. This study aims to investigate overall survival (OS) and chemotherapy receipt post-surgery in women with diabetes and localised breast cancer.

METHODS

Cohorts were constructed from electronic patient records on TriNetX, a de-identified patient database. Three cohorts included women with diabetes stratified by localised breast cancer stage (1 & 2, 3 and all), compared to control groups without diabetes. Cohorts were propensity score matched for age, ethnicity, smoking status and BMI. OS and chemotherapy receipt were compared.

RESULTS

Patients with diabetes ( = 1,488) were significantly older, more likely to smoke and had higher BMIs than those without diabetes ( = 7,284). The unadjusted hazard ratio (HR) for OS across all cancer stages was 2.17 (95% CI: 1.90-2.485) and the adjusted HR was 1.69 (95% CI: 1.41-2.04). After further adjusting for vascular diseases, the HR for OS was 1.59 (95% CI: 1.32-1.92). No significant difference was found in chemotherapy receipt.

CONCLUSION

We observed significantly poorer OS in women with breast cancer and diabetes across all stages, compared to those without diabetes. Importantly, this persisted after adjusting for confounders and cardiovascular diseases, supporting that diabetes directly influences cancer outcomes.

摘要

目的

2型糖尿病（T2DM）和癌症是常见病症，有证据表明T2DM与更高的乳腺癌发病率和死亡率相关。然而，糖尿病乳腺癌患者的额外死亡率是否由癌症相关因素驱动尚不确定。本研究旨在调查糖尿病合并局部乳腺癌女性患者的总生存期（OS）及术后化疗情况。

方法

从TriNetX（一个经过去识别处理的患者数据库）的电子病历中构建队列。三个队列包括按局部乳腺癌分期（1&2期、3期和所有分期）分层的糖尿病女性患者，并与无糖尿病的对照组进行比较。对队列进行年龄、种族、吸烟状况和体重指数的倾向评分匹配。比较总生存期和化疗情况。

结果

糖尿病患者（n = 1488）比无糖尿病患者（n = 7284）年龄显著更大，吸烟可能性更高，体重指数也更高。所有癌症分期的总生存期未调整风险比（HR）为2.17（95%CI：1.90 - 2.485），调整后HR为1.69（95%CI：1.41 - 2.04）。在进一步调整血管疾病因素后，总生存期的HR为1.59（95%CI：1.32 - 1.92）。化疗情况未发现显著差异。

结论

我们观察到，与无糖尿病的女性相比，所有分期的乳腺癌合并糖尿病女性患者的总生存期显著更差。重要的是，在调整混杂因素和心血管疾病后，这种情况仍然存在，支持糖尿病直接影响癌症预后。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1a9b/12243097/09abbc3a36c0/EO-24-0039fig6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1a9b/12243097/f5708bf72b8d/EO-24-0039fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1a9b/12243097/41c5f583e4d4/EO-24-0039fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1a9b/12243097/94379b713827/EO-24-0039fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1a9b/12243097/441c9e8b897d/EO-24-0039fig4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1a9b/12243097/6543e8c72d96/EO-24-0039fig5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1a9b/12243097/09abbc3a36c0/EO-24-0039fig6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1a9b/12243097/f5708bf72b8d/EO-24-0039fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1a9b/12243097/41c5f583e4d4/EO-24-0039fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1a9b/12243097/94379b713827/EO-24-0039fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1a9b/12243097/441c9e8b897d/EO-24-0039fig4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1a9b/12243097/6543e8c72d96/EO-24-0039fig5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1a9b/12243097/09abbc3a36c0/EO-24-0039fig6.jpg

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本文引用的文献

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Preexisting Diabetes and Breast Cancer Treatment Among Low-Income Women.低收入女性的既有糖尿病与乳腺癌治疗。
JAMA Netw Open. 2024 May 1;7(5):e249548. doi: 10.1001/jamanetworkopen.2024.9548.
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