中国肿瘤临床
中國腫瘤臨床
중국종류림상
CHINESE JOURNAL OF CLINICAL ONCOLOGY
2013年
17期
1042-1046
,共5页
孙蓓%侯国芳%张霄蓓%郝晓甍%张晟
孫蓓%侯國芳%張霄蓓%郝曉甍%張晟
손배%후국방%장소배%학효맹%장성
luminal%B型乳腺癌%糖尿病%二甲双胍%预后
luminal%B型乳腺癌%糖尿病%二甲雙胍%預後
luminal%B형유선암%당뇨병%이갑쌍고%예후
luminal B breast cancer%diabetes%metformin%prognosis
目的：探讨luminal B型乳腺癌合并糖尿病患者临床病理特征及预后特点。方法：选取天津医科大学肿瘤医院2002年1月至2006年12月收治的luminal B型乳腺癌4401例，其中合并糖尿病乳腺癌479例及未合并糖尿病乳腺癌3392例。按照高敏感性luminal B和Her-2阳性luminal B两种亚型分组进行对比研究。各亚型进一步分组为二甲双胍治疗组、非二甲双胍治疗组和非糖尿病组。研究指标包括乳腺癌死亡率、临床病理分期、淋巴结状况、化疗方案及内分泌治疗方案。Kaplan-Meier方法分析各分组之间死亡率是否存在差异。Cox比例风险模型用于检测与预后相关的独立因素。结果：Kaplan-Meier单因素分析法显示高敏感性luminal B、Her-2阳性luminal B型中二甲双胍治疗组、非二甲双胍治疗组和非糖尿病组癌症死亡率均存在显著性差异，5年生存率依次为93.5%、81.0%、89.0%（P<0.001）和84.0%、77.0%、83.0%（P=0.035）。Cox回归模型多因素分析显示两类分型中相对于二甲双胍治疗组，非二甲双胍治疗组预后较差（P<0.001，P=0.044）。但仅高敏感性luminal B分型相对于二甲双胍治疗组，非糖尿病组预后较差（P=0.038）。临床特征方面，二甲双胍治疗组和非二甲双胍治疗组T3～4期患者比例高（P<0.001），更易发生淋巴结转移（P=0.001）。结论：luminal B型乳腺癌分型中以二甲双胍治疗组作为参考，非二甲双胍治疗组均预示较差的预后，其中仅高敏感性luminal B分型中非糖尿病组预示了较差的预后。糖尿病用药对不同的luminal B分型乳腺癌患者预后影响可能不同。
目的：探討luminal B型乳腺癌閤併糖尿病患者臨床病理特徵及預後特點。方法：選取天津醫科大學腫瘤醫院2002年1月至2006年12月收治的luminal B型乳腺癌4401例，其中閤併糖尿病乳腺癌479例及未閤併糖尿病乳腺癌3392例。按照高敏感性luminal B和Her-2暘性luminal B兩種亞型分組進行對比研究。各亞型進一步分組為二甲雙胍治療組、非二甲雙胍治療組和非糖尿病組。研究指標包括乳腺癌死亡率、臨床病理分期、淋巴結狀況、化療方案及內分泌治療方案。Kaplan-Meier方法分析各分組之間死亡率是否存在差異。Cox比例風險模型用于檢測與預後相關的獨立因素。結果：Kaplan-Meier單因素分析法顯示高敏感性luminal B、Her-2暘性luminal B型中二甲雙胍治療組、非二甲雙胍治療組和非糖尿病組癌癥死亡率均存在顯著性差異，5年生存率依次為93.5%、81.0%、89.0%（P<0.001）和84.0%、77.0%、83.0%（P=0.035）。Cox迴歸模型多因素分析顯示兩類分型中相對于二甲雙胍治療組，非二甲雙胍治療組預後較差（P<0.001，P=0.044）。但僅高敏感性luminal B分型相對于二甲雙胍治療組，非糖尿病組預後較差（P=0.038）。臨床特徵方麵，二甲雙胍治療組和非二甲雙胍治療組T3～4期患者比例高（P<0.001），更易髮生淋巴結轉移（P=0.001）。結論：luminal B型乳腺癌分型中以二甲雙胍治療組作為參攷，非二甲雙胍治療組均預示較差的預後，其中僅高敏感性luminal B分型中非糖尿病組預示瞭較差的預後。糖尿病用藥對不同的luminal B分型乳腺癌患者預後影響可能不同。
목적：탐토luminal B형유선암합병당뇨병환자림상병리특정급예후특점。방법：선취천진의과대학종류의원2002년1월지2006년12월수치적luminal B형유선암4401례，기중합병당뇨병유선암479례급미합병당뇨병유선암3392례。안조고민감성luminal B화Her-2양성luminal B량충아형분조진행대비연구。각아형진일보분조위이갑쌍고치료조、비이갑쌍고치료조화비당뇨병조。연구지표포괄유선암사망솔、림상병리분기、림파결상황、화료방안급내분비치료방안。Kaplan-Meier방법분석각분조지간사망솔시부존재차이。Cox비례풍험모형용우검측여예후상관적독립인소。결과：Kaplan-Meier단인소분석법현시고민감성luminal B、Her-2양성luminal B형중이갑쌍고치료조、비이갑쌍고치료조화비당뇨병조암증사망솔균존재현저성차이，5년생존솔의차위93.5%、81.0%、89.0%（P<0.001）화84.0%、77.0%、83.0%（P=0.035）。Cox회귀모형다인소분석현시량류분형중상대우이갑쌍고치료조，비이갑쌍고치료조예후교차（P<0.001，P=0.044）。단부고민감성luminal B분형상대우이갑쌍고치료조，비당뇨병조예후교차（P=0.038）。림상특정방면，이갑쌍고치료조화비이갑쌍고치료조T3～4기환자비례고（P<0.001），경역발생림파결전이（P=0.001）。결론：luminal B형유선암분형중이이갑쌍고치료조작위삼고，비이갑쌍고치료조균예시교차적예후，기중부고민감성luminal B분형중비당뇨병조예시료교차적예후。당뇨병용약대불동적luminal B분형유선암환자예후영향가능불동。
Objective:To investigate the clinical, pathological, and prognostic characteristics of luminal B breast cancer patients with diabetes. Methods:A total of 479 luminal B breast cancer patients with diabetes and 3 392 luminal B breast cancer patients without diabetes who were treated between January 2002 and December 2006 were enrolled in this study. The luminal B breast cancer patients were further divided into the luminal B (high ki67) and luminal B (Her-2/neu+) subgroups. Each subgroup was further grouped into metformin-treated, non-metformin-treated, and non-diabetic groups. The indicators included cancer-specific mortality, clinical, pathological stage, lymph node status, chemotherapy, and endocrine therapy. The survival analysis of each group was performed using the Kaplan-Meier method, and the significance was determined using the logrank test. Cox proportional hazard model was used to examine the correlation between each factor and the prognosis. Results:The Kaplan-Meier analysis results revealed that the breast cancer mortality rates in the metformin-treated, non-metformin-treated, and non-diabetic groups were significantly different in both luminal B (high ki67) and luminal B (Her-2/neu+) subgroups (logrank test:P<0.001, P=0.035), and the respective five-year survival rates were 93.5%, 81%, and 89%for the luminal B (high ki67) subgroup and 84%, 77%, and 83%for the luminal B (Her-2/neu+) subgroup. The Cox multifactorial regression analysis results showed that compared with the metformin-treated group, the non-metformin-treated group was associated with a significantly increased risk of mortality (P<0.001, P=0.044) in the two subgroups. Meanwhile, the non-diabetic group was associated with an increased risk of mortality (P=0.038) in the luminal B (high ki67) subgroup only. The percentage of elderly (P<0.001), menopausal (P<0.001), obese (P<0.001), and patients with cardio-cerebrovascular complications (P<0.001) tended to be higher in the metformin-treated and non-metformin-treated groups than in the diabetic group. Moreover, the metformin-and non-metformin-treated groups in the luminal B (high ki67) subgroup were associated with high percentages of T3/4 pathological stage (P<0.001), lymph node metastasis (P=0.001). The non-metformin-treated group was associated with a lower percentage of invasive ductal carcinoma (P=0.001) compared with the other two groups. Conclusion:The non-metformin-treated group resulted in worse clinical outcomes in both subgroups compared with the metformin-treated group. Meanwhile, the non-diabetic group resulted in the worst prognosis among the three groups in the luminal B (high ki67) subgroup. These findings suggest that the choice of different anti-diabetic drugs may influence the prognosis of luminal B breast cancer patients with diabetes.
