| Objective:By exploring the relationship between type 2 diabetes mellitus and the efficacy of neoadjuvant chemotherapy for breast cancer,to determine whether type 2 diabetes mellitus was an important clinical factor in predicting the efficacy of neoadjuvant chemotherapy in breast cancer patients.Methods:The clinical and pathological data of 1176 patients who were pathologically confirmed primary invasive ductal carcinoma of breast,received neoadjuvant chemotherapy and both breast and axillary surgery in the Department of Breast Surgery,the First Hospital of Jilin University from January 2010 to December 2020 were retrospectively analyzed.The included patients were divided into T2DM group（99 cases）and nonT2DM group（1077 cases）according to whether they were diagnosed with type 2 diabetes mellitus before neoadjuvant chemotherapy.Relevant statistical analysis was performed using STATA software: quantitative data that did not conform to the normal distribution were described as median and interquartile range;qualitative data were described as rate（%）;quantitative data were compared using Wilcoxon rank sum test;qualitative data were compared using Pearson’s chi-square test or Fisher’s exact test;univariate and multivariate analysis were performed using binary logistic regression model.The propensity score matching（PSM）was applied to balance the differences in clinicopatnological characteristics of two groups in a ratio of 1:3 and the balance test was performed using R software.The differences in pathological complete response（pCR）rates after NACT between the two groups were compared and related factors were analyzed both before and after PSM.All hypothesis tests were two-sided.When performing univariate analysis,P<0.1 was regarded as statistically significant,and other hypothesis tests were considered statistically significant when P<0.05.Results:（1）There were statistically significant differences in a number of clinicopathological features between T2DM and non-T2DM groups.The T2DM group had more patients over 50 years old（78.8% vs 49.0%,P<0.001）,a higher proportion of postmenopausal patients（76.8% vs47.4%,P<0.001）,and more overweight and obese patients than the nonT2DM group（respectively 41.4% vs 37.5% and 14.1% vs 6.0%,P=0.003）.More patients in the T2DM group had stage ⅡI tumors（41.4%vs 29.9%,P=0.045）.Although there was no significant difference in c T stage between the two groups（P=0.11）,the T2DM group had more patients with c T2 stage（79.8% vs 69.5%）.The T2DM group had higher c N stage（P=0.007）,especially for c N2 and c N3 stages（33.4% vs 22.7%）.（2）Among all included patients,the incidence of pCR was lower in the T2DM group than in the non-T2DM group（7.1% vs 17.1%,P=0.010）.In different molecular typing subgroups,the pCR rates after NACT in the T2DM group were lower than those in the non-T2DM group,but the differences were not statistically significant.Multivariate analysis showed T2DM（OR: 0.375,95%CI[0.163-0.861],P=0.021）was an independent risk factor affecting pCR after NACT.（3）After PSM,the pCR rate in the T2DM group after NACT was still significantly lower than that in the non-T2DM group（7.6% vs 16.3%,P=0.038）when excluding the interference of confounding factors.Multivariate analysis result of T2DM was consistent with that before PSM（OR: 0.357,95% CI [0.144-0.882],P=0.026）.Conclusion:（1）Among breast cancer patients with T2DM who underwent NACT,the proportions of elderly,postmenopausal,overweight and obese patients were higher and the tumor stage was later.（2）This study comprehensively analyzed the PSM results and traditional multivariate regression results,showing that T2DM was an independent risk factor affecting pCR after NACT in breast cancer patients and might become one of the clinical factors predicting the efficacy of NACT,which needed further verification. |
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