Is insulin resistance a predictor for complete response in breast cancer patients who underwent neoadjuvant treatment?
Is insulin resistance a predictor for complete response in breast cancer patients who underwent neoadjuvant treatment?
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DOI：
10.1186/s12957-020-02019-y
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发表时间：
2020-09-09
影响因子：
3.2
通讯作者：
Yumuk, Perran Fulden
中科院分区：
文献类型：
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作者：
Alan, Ozkan;Akin Telli, Tugba;Yumuk, Perran Fulden
目的新辅助化疗是局部晚期乳腺癌的标准一线治疗方式。达到病理完全缓解（pCR）是延长无病生存期和总生存期的重要预后因素。胰岛素抵抗被定义为胰岛素作用在骨骼肌、肝脏和脂肪组织等外周靶组织受损的病理状态。乳腺癌和胰岛素抵抗之间的关系是有争议的。在这项研究中，我们的目的是评估胰岛素抵抗、体重指数（BMI）、代谢综合征和炎症标志物在预测接受新辅助治疗的乳腺癌患者完全缓解中的作用。方法回顾性分析2015年至2017年55例局部晚期非糖尿病性乳腺癌患者接受新辅助化疗的资料。稳态模型评估，IR =胰岛素抵抗（HOMA-IR），采用新辅助化疗前获得的胰岛素和空腹血糖值（空腹胰岛素x空腹血糖/405）计算。我们认为胰岛素抵抗的临界值是2.5。计算全身炎症指数（SII）、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）。结果25例患者无胰岛素抵抗。最常见的病理亚型（56%）是激素受体（HR）阳性和人表皮生长因子受体-2 （Her-2）阴性的浸润性导管癌。16例（29%）患者病理完全缓解（pCR）。我们发现，胰岛素抵抗患者发生pCR的概率比无胰岛素抵抗患者低4.7倍[OR: 4.7 (95%CI 1.7 ~ 17.2),p= 0.01]。结论胰岛素抵抗可能对新辅助治疗后的病理完全缓解（pCR）有负面影响，特别是对激素阳性和her -2阴性的非糖尿病乳腺癌患者。
Purpose Neoadjuvant chemotherapy is the standard front-line treatment modality in locally advanced breast cancer. Achieving pathological complete response (pCR) is a significant prognostic factor for prolonged disease-free and overall survival. Insulin resistance is defined as a pathological condition in which insulin effect is impaired in peripheral target tissues such as the skeletal muscle, liver, and adipose tissue. The relationship between breast cancer and insulin resistance is controversial. In this study, our aim is to evaluate the role of insulin resistance, body mass index (BMI), metabolic syndrome, and inflammation markers to predict complete response in breast cancer patients who underwent neoadjuvant treatment. Methods Data from 55 locally advanced non-diabetic breast cancer patients, treated with neoadjuvant chemotherapy between 2015 and 2017, were retrospectively evaluated. Homeostatic model assessment, IR = insulin resistance (HOMA-IR) was calculated by using the obtained insulin and fasting blood glucose values before neoadjuvant chemotherapy (fasting insulin x fasting glucose/405). We considered a cut-off of 2.5 for insulin resistance. The systemic inflammatory index (SII), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) were calculated. Results Twenty-five patients had no insulin resistance. The most common pathologic subtype (56%) was hormone receptor (HR) positive and human epidermal growth factor receptor-2 (Her-2)-negative invasive ductal carcinoma. Sixteen (29%) patients had a pathological complete response (pCR). We found that the probability of pCR in patients with insulin resistance was 4.7 times lower than that in patients without insulin resistance [OR: 4.7 (95%CI 1.7-17.2),p= 0.01]. Conclusion Our results revealed that insulin resistance may have a negative effect on pathological complete response (pCR) following neoadjuvant therapy particularly with hormone-positive and Her-2-negative cases of non-diabetic breast cancer.