Clinically Defined Type 2 Diabetes Mellitus and Prognosis in Early-Stage Breast Cancer
Clinically Defined Type 2 Diabetes Mellitus and Prognosis in Early-Stage Breast Cancer
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DOI：
10.1200/jco.2010.29.3183
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发表时间：
2011-01-01
影响因子：
45.3
通讯作者：
Pierce, John P.
中科院分区：
文献类型：
--
作者：
Erickson, Kirsten;Patterson, Ruth E.;Pierce, John P.
目的自我报告的糖尿病与乳腺癌预后不良有关。需要研究生物决定的血糖控制与乳腺癌预后的关系。方法利用妇女健康饮食和生活研究的存档基线血液样本，对3003名早期乳腺癌幸存者(确诊年龄28至70岁)进行血红蛋白A1C(HbA1C)测定，观察时间中值为额外乳腺癌事件7.3年，全因死亡10.3年。HbA1c水平提供了慢性血糖水平的准确、精确的测量。结果仅5.8%的女性有慢性高血糖(定义为HbA1C水平和Gt；=6.5%)。那些HbA1C>；=6.5%的人年龄较大，受教育程度较低，非白人种族，肥胖，确诊时患有更晚期的乳腺癌。HbA1c与总存活率显著相关(P-Trend<；.001)。调整混杂因素后，HbA1C和HbA1C=7.0%的女性全因死亡的风险是HbA1C<6.5%的女性的两倍(风险比[HR]，2.35；95%CI，1.56至3.54)。对于无病生存，HbA1C水平的风险增加30%=7.0%(HR，1.26；95%CI，0.78至2.02)。在研究随访中，先前诊断的糖尿病而不是未诊断的糖尿病似乎是风险增加的原因。结论慢性高血糖与早期乳腺癌幸存者的总体生存率下降在统计学上显著相关。进一步研究糖尿病及其与乳腺癌预后的关系是有必要的。
PurposeSelf-reported diabetes has been associated with poor breast cancer outcomes. Research is needed to investigate the relationship between biologically determined glycemic control and breast cancer prognosis.MethodsArchived baseline blood samples from the Women's Healthy Eating and Living Study were used to measure hemoglobin A1C (HbA1C) among 3,003 survivors of early-stage breast cancer (age of diagnosis, 28 to 70 years) observed for a median of 7.3 years for additional breast cancer events and 10.3 years for all-cause mortality. HbA1C levels provide an accurate, precise measure of chronic glycemic levels. Cox regression analysis was performed to assess whether baseline HbA1C levels predicted disease-free and overall survival.ResultsOnly 5.8% of women had chronic hyperglycemia (defined as HbA1C levels >= 6.5%). Those with HbA1C >= 6.5% were older and more likely to be less educated, have nonwhite ethnicity, be obese, and have more advanced breast cancer at diagnosis. HbA1C was significantly associated with overall survival (P-trend < .001). After adjusting for confounders, risk of all-cause mortality was twice as high in women with HbA1C >= 7.0% compared with women with HbA1C less than 6.5% (hazard ratio [HR], 2.35; 95% CI, 1.56 to 3.54). For disease-free survival, there was a nonsignificant 30% increase in risk for HbA1C levels >= 7.0% (HR, 1.26; 95% CI, 0.78 to 2.02). During study follow-up, previously diagnosed rather than undiagnosed diabetes seemed to account for the increased risk.ConclusionChronic hyperglycemia is statistically significantly associated with reduced overall survival in survivors of early-stage breast cancer. Further study of diabetes and its relationship to breast cancer outcomes is warranted.