Clinicopathological Characteristics And Prognosis Of Patients With Early Invasive Breast Cancer Complicated With Type 2 Diabetes

Objective: During the last two decades,the incidence of breast cancer has risen dramatically,and breast cancer is becoming the most common malignancy in women around the world,which has seriously impacted the female health.Although there are varieties of risk factors,such as age,genetic factors,menstrual status,reproductive and lifestyles,however oncologists have not paid appropriate attention to certain metabolic factors which may play a major role in breast cancer development.Type 2 diabetes mellitus is one of the most common chronic disease worldwide and affects all cross-sections of the society including children,women,youth and adults.Scientific evidence correlates diabetes with higher rates of different cancers,accelerated disease progression and aggressiveness.In many previous studies,the link between diabetes and breast cancer risk and prognosis has gradually been paid attention to.Commonly used anti-diabetic drugs,such as metformin,have recently become more and more popular in the treatment of breast cancer due to their anti-cancer properties.The purpose of this study was to investigate the clinical characteristics and prognosis of patients with early breast cancer combined with type 2 diabetes,and to further analyze the impact of treatment methods of type 2 diabetes on the breast cancer prognosis.Methods: A total of 3,757 cases of primary breast cancer were diagnosed at the Breast Center of The Fourth Hospital of Hebei Medical University between January 2010 and December 2013 and were collected in this study.According to the screening criteria of this trial,3553 patients were finally enrolled,including 414 breast cancer patients with type 2 diabetes.The count data was expressed by frequency,and comparison of count data between groups was by chi-square test.The log-rank test was used to compare the survival of different patients.The COX proportional hazard regression model was used to explore the factors affecting the survival of patients.The follow-up data was compiled and entered into SPSS21.0 for statistical analysis.Results:1.The clinicopathological characteristics of breast cancer with type 2 diabetesCompared with non-diabetic breast cancer patients,breast cancer patients with type 2 diabetes were older,with a higher body mass index(BMI),smaller tumors,fewer lymph node metastases,lower Ki-67 expression levels,and triple negative type Breast cancer accounts for relatively few.2.The prognosis of breast cancer with type 2 diabetes2.1 The Kaplan-Meier survival curve showed that the overall survival time(OS)and disease-free survival(DFS)were different between the group with type 2 diabetes and non-diabetic breast cancer group.OS and DFS were longer in patients with type 2 diabetes(P = 0.002,P = 0.001).2.2 In patients with type 2 diabetes,the blood glucose control methods and control conditions had statistical differences in overall survival time(OS)and disease-free survival(DFS),respectively.In its blood glucose control method,the metformin group had a statistically significant difference compared to the insulin group.The metformin group had better OS and DFS than the insulin group(P = 0.000).In its blood glucose control situation,the better the blood glucose control,the better the prognosis.3.Univariate analysis and COX regression analysisUnivariate analysis showed that type 2 diabetes,age,tumor size,BMI,pathological type,lymph node metastasis,ER status,PR status,Her-2 status,Ki-67 expression,molecular typing,and endocrine therapy were the significant factors to DFS and OS of breast cancer patients(P<0.05).COX regression multivariate analysis showed that type 2 diabetes,age,tumor size,BMI,lymph node metastasis,ER status,PR status,and Ki-67 expression were factors that affected the recurrence,metastasis,and survival of breast cancer patients(P <0.05).Among patients with type 2 diabetes,age,lymph node metastasis,glycemic control,and ways of glycemic control were independent prognostic factors that affected the recurrence,metastasis,and survival of patients with breast cancer(P <0.05).Conclusions:1.Patients with breast cancer combined with type 2 diabetes were older,had fewer lymph node metastases,lower Ki-67 expression,fewer triple negative breast cancer patients.2.Compared with non-diabetic breast cancer patients,patients with type 2 diabetes have a better prognosis.3.In patients with type 2 diabetic breast cancer,the use of metformin may reduce its risk of recurrence,metastasis and death.