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目的探讨合并2型糖尿病乳腺癌患者的临床特征、分子表型及预后,为乳腺癌个体化治疗提供依据。方法回顾分析2005年1月至2010年12月南昌市第三医院收治的105例合并2型糖尿病乳腺癌患者和随机抽取的同期200例非糖尿病乳腺癌患者的临床资料,并进行预后生存分析。结果糖尿病组较对照组的乳腺癌患者年龄更大,平均(57.2±21.8)岁,绝经后患者比例更高,约71.4%,病理分级更高,Ⅱ～Ⅲ级比例为98.8%,新辅助化疗疗效更差,化疗有效率为67.5%,差异均有统计学意义(P<0.05),但两组在肿瘤大小、临床分期、淋巴结转移数量及分子分型上差异无统计学意义(P>0.05);糖尿病组的无病生存率和总生存率分别为80.2%和84.2%,均较对照组更差,两者差异有统计学意义(P<0.05),且剔除其他原因死亡患者后分析总生存率结果仍显示糖尿病组更差,但差异无统计学意义(P>0.05);糖尿病组的乳腺癌患者空腹及餐后2h血清胰岛素均高于正常值,对照组血清胰岛素水平都属于正常范围。结论糖尿病组乳腺癌患者中绝经后的老年患者更多,高病理分级比例更高,新辅助化疗疗效更差,合并糖尿病是乳腺癌患者预后不良的危险因素。高胰岛素血症可能是影响糖尿病组乳腺癌患者预后差的重要原因。
Objective To investigate the clinical features, molecular phenotypes and prognosis of patients with type 2 diabetes mellitus complicated with breast cancer and provide basis for individualized treatment of breast cancer. Methods The clinical data of 105 patients with type 2 diabetes mellitus and 200 patients with non-diabetic breast cancer who were randomly selected from the Third Hospital of Nanchang from January 2005 to December 2010 were retrospectively analyzed and the prognosis of the patients were analyzed. Results The diabetic patients were older than the control group (mean age 57.2 ± 21.8 years). The proportion of postmenopausal patients was higher (71.4%), the pathological grade was higher, and the grade Ⅱ ~ Ⅲ was 98.8%. Neoadjuvant chemotherapy The curative effect was worse, the effective rate of chemotherapy was 67.5%, the differences were statistically significant (P <0.05), but there was no significant difference between the two groups in tumor size, clinical stage, lymph node metastasis number and molecular typing (P> 0.05 ). The disease-free survival rate and overall survival rate in diabetic group were 80.2% and 84.2%, respectively, which were significantly lower than those in control group (P <0.05). After excluding patients with other causes of death, The results of survival rate still showed that the diabetic group was worse, but the difference was not statistically significant (P> 0.05). The serum insulin levels of fasting and postprandial 2h groups in diabetic patients were both higher than the normal values. The serum insulin levels in the control group all belonged to the normal range . Conclusion In elderly patients with diabetes mellitus, there are more elderly patients with high postmenopausal breast cancer, higher proportion of high pathological grading, and neoadjuvant chemotherapy with poorer efficacy. Combined diabetes mellitus is a risk factor for poor prognosis in patients with breast cancer. Hyperinsulinemia may be an important reason for poor prognosis in patients with diabetes mellitus.