乳腺癌辅助化疗诱发2型糖尿病患者预后因素及生存分析  

Pathological Characteristics,Influencing Factors of Prognosis and Survival Analysis of Type 2 Diabetes Mellitus Patients Induced by Adjuvant Chemotherapy for Breast Cancer

作　　者：李秋华[1] 葛亚楠[2] 刘兆喆[2] 谢晓冬[2] LI Qiu-hua GE Ya-nan LIU Zhao-zhe XIE Xiao-dong(Liaoning University of Traditional Chinese Medicine, Shenyang 110847, China Diagnosis and Treatment Center of Cancer of PLA, General Hospital of Shenyang Military Area Command, Shenyang 110016, China)

机构地区：[1]辽宁中医药大学,沈阳110847 [2]沈阳军区总医院全军肿瘤诊治中心,沈阳110016

出　　处：《临床误诊误治》2016年第10期84-88,共5页Clinical Misdiagnosis & Mistherapy

基　　金：科技部十二五重大新药创制平台子课题(2012ZX-09303016);2012年辽宁省科技攻关计划课题(2012225019);2014年辽宁省中医药临床专(学)科能力建设项目(2014-lnzyxzk-05)

摘　　要：目的 总结乳腺癌辅助化疗诱发2型糖尿病（type 2 diabetes mellitus,T2DM）的临床病理特征,探讨其预后影响因素及生存情况。方法 选取2009年1月30日—2014年1月30日沈阳军区总医院肿瘤科收治的女性乳腺癌辅助化疗患者184例,将化疗诱发T2DM者46例作为观察组,未诱发T2DM者138例作为对照组。比较两组临床病理特征,采用Cox单因素和多因素回归分析乳腺癌辅助化疗患者不良预后影响因素,并随访观察两组3年、5年无病生存率。结果 两组文化程度、糖尿病家族史、体重指数（BMI）、血脂异常、C-反应蛋白（CRP）、血清胱抑素C（Cys-c）、雌激素受体（ER）阴性、孕激素受体（PR）阴性、化疗方案、辅助放疗、辅助靶向治疗方面比较差异均有统计学意义（P〈0.05或P〈0.01）。Cox多因素回归分析显示：ER阴性、CRP多次异常、化疗诱发T2DM是乳腺癌辅助化疗患者不良预后的独立危险因素（95%CI：0.294-0.702,P=0.006;95%CI：1.405-2.931,P=0.039;95%CI：1.592-2.837,P=0.019）。观察组3年、5年无病生存率（65.2%、54.3%）显著低于对照组（81.9%、70.3%）,差异有统计学意义（χ^2=4.911,P=0.026;χ^2=4.324,P=0.038）。结论 ER阴性、CRP多次异常、化疗诱发T2DM是乳腺癌辅助化疗患者不良预后的独立危险因素,乳腺癌辅助化疗诱发T2DM者较未诱发T2DM者无病生存期缩短。Objective To summarize pathological characteristics of type 2diabetes mellitus （T2DM） patients induced by adjuvant chemotherapy for breast cancer, and to study influencing factors of prognosis and survival analysis. Methods A total of 184 breast cancer females undergoing adjuvant chemotherapy during January 30, 2009 and January 30, 2014 were divided into patients induced by T2DM （observation group, n = 46） and patients without T2DM （control group, n = 138）. Pathological characteristics were compared between two groups, and influencing factors of prognosis were analyzed by Cox single factor and multiple factors regression analysis, and disease-free survival rates were also observed in 3^rd and 5^th years during follow-up in two groups. Results There were significant differences in culture degree, family history of diabetes mellitus, body mass index （BMI） , dyslipidemia, c-reactive protein （CRP） , cystatin-c （Cys-c） , negative estrogen receptor （ER） and progesterone receptor （PR） , chemotherapy plan, adjuvant radiotherapy and targeted therapy between two groups （P 〈 0.05 or P 〈0.01 ）. Cox single factor and multiple factors regression analysis showed that negative ER, CRP abnormalities for many times and T2DM induced by chemotherapy were independent risk factors for poor prognosis of patients （95% CI： 0. 294 - 0.702, P=0.006; 95% CI： 1.405-2.931, P=0.039; 95% CI： 1.592-2.837, P=0.019）. Disease-free survival rates in 3^rd and 5^th years in observation group （65.2% , 54.3% ） were significantly lower than 81.9% and 70.3% in control group （χ^2 =4.911, P =0.026; χ^2 =4.324, P =0.038）. Conclusion Negative ER, CRP abnormalities for many times and T2DM induced by chemotherapy are independent risk factors for poor prognosis of patients, and disease-free survival period of chemotherapy-induced T2DM patients is shorter than that of patients without chemotherapy-induced T2DM patients.

关 键 词：乳腺肿瘤 抗肿瘤联合化疗方案 糖尿病 2型 预后 影响因素分析 生存分析 

分 类 号：R737.9[医药卫生—肿瘤] R587.1[医药卫生—临床医学]