Fasting insulin and outcome in early-stage breast cancer: Results of a prospective cohort study
Fasting insulin and outcome in early-stage breast cancer: Results of a prospective cohort study
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DOI：
10.1200/jco.20.1.42
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发表时间：
2002-01-01
影响因子：
45.3
通讯作者：
Hood, N
中科院分区：
文献类型：
--
作者：
Goodwin, PJ;Ennis, M;Hood, N
目的：胰岛素是生长因子家族的一员，包括胰岛素样生长因子（IGF）-I和IGF-II，通过胰岛素和IGF-I受体对正常和恶性乳腺上皮细胞发挥促有丝分裂作用。正因为如此，因为它的公认的关联与肥胖，乳腺癌的不良预后因素，我们研究了胰岛素在早期乳腺cancer.Patient和方法的预后协会：一个队列的512名妇女没有已知的糖尿病，谁有早期（T1至T3，N 0至N1，和M0）乳腺癌，组装和前瞻性观察。结果：空腹胰岛素水平与远处复发和死亡相关;风险比和95%置信区间（CI）最高（> 51.9 pmol/L）与最低（< 27.0 pmol/L）胰岛素四分位数分别为2.0（95% CI，1.2 - 3.3）和3.1（95% CI，1.7 - 5.7）。有一些证据表明，胰岛素与乳腺癌结局的关系可能是非线性的。胰岛素与体重指数相关（斯皮尔曼r = 0.59，P <0.001），而体重指数又与远处复发和死亡相关（P <0.001）。在多变量分析，包括空腹胰岛素和可用的肿瘤和治疗相关的变量，调整后的风险比为上与下胰岛素四分位数分别为2.1（95%CI，1.2至3.6）和3.3（95%CI，1.5至7.0）的远端复发和deaths.Conclusion：空腹胰岛素水平与妇女早期乳腺癌的结局。高水平的空腹胰岛素可识别出预后不良的女性，应探索更有效的治疗策略。(C)2001年，美国临床肿瘤学会。
Purpose: Insulin, a member of a family of growth factors that includes insulin-like growth factor (IGF)-I and IGF-II, exerts mitogenic effects on normal and malignant breast epithelial cells, acting via insulin and IGF-I receptors. Because of this and because of its recognized association with obesity, an adverse prognostic factor in breast cancer, we examined the prognostic associations of insulin in early-stage breast cancer.Patient and Methods: A cohort of 512 women without known diabetes, who had early-stage (T1 to T3, N0 to N1, and M0) breast cancer, was assembled and observed prospectively. Information on traditional prognostic factors and body size was collected, and fasting blood was obtained.Results: Fasting insulin was associated with distant recurrence and death; the hazard ratios and 95% confidence intervals (CI) for those in the highest (> 51.9 pmol/L) versus the lowest (< 27.0 pmol/L) insulin quartile were 2.0 (95% CI, 1.2 to 3.3) and 3.1 (95% Cl, 1.7 to 5.7), respectively. There was some evidence to suggest that the association of insulin with breast cancer outcomes may be nonlinear. Insulin was correlated with body mass index (Spearman r = 0.59, P < .001), which, in turn, was associated with distant recurrence and death (P < .001). In multivariate analyses that included fasting insulin and available tumor- and treatment-related variables, adjusted hazard ratios for the upper versus lower insulin quartile were 2.1 (95% Cl, 1.2 to 3.6) and 3.3 (95% Cl, 1.5 to 7.0) for distant recurrence and death, respectively.Conclusion: Fasting insulin level is associated with outcome in women with early breast cancer. High levels of fasting insulin identify women with poor outcomes in whom more effective treatment strategies should be explored. (C) 2001 by American Society of Clinical Oncology.