术前胰岛素水平对非糖尿病乳腺癌患者预后的价值  

Prognostic Value of Preoperative Insulin Levels in Patients with Non-diabetic Breast Cancer

作　　者：杨永德[1] 周焱琳[2] 王梦远[1] 

机构地区：[1]重庆三峡中心医院乳腺外科,重庆404000 [2]重庆三峡中心医院健康管理中心,重庆404000

出　　处：《医学综述》2017年第22期4561-4565,共5页Medical Recapitulate

摘　　要：目的探讨术前血清胰岛素水平对非糖尿病乳腺癌患者预后的价值。方法选择2010年1月至2014年12月于重庆三峡中心医院进行治疗的286例原发性乳腺癌患者,经排除后,216例非糖尿病乳腺癌患者纳入研究,设为乳腺癌组,按1∶2比例匹配年龄、血脂、体质指数的健康女性设为对照组,比较两组的临床资料及血糖指标;采用受试者工作特征(ROC)曲线分析计算乳腺癌组血清胰岛素的截断值,按最佳节点值分为高低两组;采用Kaplan-Meier法绘制患者生存曲线;获得完整随访资料的有196例非糖尿病乳腺癌患者,采用Cox回归模型对乳腺癌患者预后影响因素进行分析。结果乳腺癌组空腹血糖、胰岛素、HOMA-IRI显著高于健康对照组(P<0.05),两组糖化血红蛋白比较差异无统计学意义(P>0.05);ROC确定血清胰岛素为10.3 m U/L作为乳腺癌患者疾病进展的最佳截断点;Kaplan-Meier分析10.3 m U/L及<10.3 m U/L两组无进展生存时间比较差异有统计学意义(P<0.05),血清胰岛素≥10.3 m U/L组预后差;Cox单因素分析影响无进展生存时间(PFS)的有肿瘤分级(HR=1.43,95%CI 1.05~1.95)、肿瘤分期(HR=1.52,95%CI 1.16~1.98)、空腹胰岛素(HR=1.79,95%CI 1.07~2.98)(P<0.05);Cox多因素分析影响无进展生存时间的有肿瘤分级(HR=1.38,95%CI 1.03~1.85)、肿瘤分期(HR=1.83,95%CI 1.12~2.98)、空腹胰岛素(HR=2.02,95%CI 1.90~3.78)(P<0.05)。结论术前血清胰岛素水平对非糖尿病乳腺癌患者的无进展生存时间的预测有临床意义。Objective To evaluate the expression and clinical significance of serum insulin levels in patients with non- diabetic breast cancer. Methods A total of 286 patients with primary breast cancer were selected from Chongqing Sanxia Central Hospital during Jan. 2010 and Dec. 2014, and only 216 patients with non-diabetic breast cancer were included as a breast cancer group, and 432 healthy women （ 1 ： 2 ） matched in age, blood lipid levels, and body mass index were included as a control group. The clinical data and blood glucose parameters were compared between the two groups. Receiver-operating characteristic （ROC） curve analysis was applied to determine the best cutoff values for insulin ＇and according to the best value is the patients were divided into a high level group and a low level group to compare their clinical data;the survival curve was drawn by Kaplan-Meier method, and the prognostic factors of breast cancer patients were analyzed by Cox regression model. Results The fasting blood glucose and insulin of the breast cancer group and control group were statisti-cally significant （P 〈0. 05 ）, while the glycosylated hemoglobin was not statistically significant （P 〉 0.05） ;the ROC determined optimal cut-off point of insulin was 10.3 mU/L for the prognosis of patients with breast cancer and there were significant differences in pathological typing, tumor stage and progression between the group of fasting insulin ≥10.3 mU/L and the group of fasting insulin 〈 10.3 mU/L. Kaplan-Meier analysis showed that the group of serum insulin≥ 10.3 mU/L had shorter progression free survival （PFS） and poor prognosis. Cox analysis of univariable factors associated with PFS （ P 〈 0.05 ） included tumor grade （ HR=- 1.37,95 % CI 1.08-1.76 ）, tumor stage （ HR = 1.36,95 % CI 1.15-1.62）, and fasting insulin（ HR = 2.11 ; 95% CI 1.19-3.77 ） ; Cox analysis of multivariable factors associated PFS （P 〈0.05） included tumor grade（HR =- 1.31,95% CI 1.03-1.65） ,tumor stage（HR = 1.4

关 键 词：乳腺癌 胰岛素 无进展生存时间 稳态评估模型一胰岛素抵抗指数 预测 

分 类 号：R737.9[医药卫生—肿瘤]