title: Clinical pathological characteristics of breast cancer patients with secondary diabetes after systemic therapy: a retrospective multicenter study.
abstract: The objective of this study was to investigate the clinical pathological characteristics of breast cancer (BC) patients with secondary diabetes after systemic therapy without preexisting diabetes. A total of 1434 BC patients received systemic therapy and were analyzed retrospectively. Fasting plasma glucose (FPG) levels were monitored prior to the treatments, during the course of systemic therapy, and at the follow-up visits. Cox regression models were used to estimate the associations between the clinical pathological characteristics of BC and the cause-specific hazard of developing secondary diabetes. Among the 1434 BC patients, 151 had preexisting type 2 diabetes. Of the remaining 1283 patients with normal FPG levels prior to the systemic therapy, 59 developed secondary diabetes and 72 displayed secondary impaired fasting glucose (IFG) over a mean follow-up of 41 months. The prevalence of secondary type 2 diabetes in BC patients was 4.6 % (59/1283), which was obviously higher than that of the normal control group (1.4 %, P < 0.001). The percentage of older patients (P < 0.05), menopausal patients (P < 0.001), and obese patients (P < 0.01) tended to be lower in the secondary diabetic group. In addition, these patients with secondary diabetes had later pathological stages (P < 0.01), more lymph node metastasis (P < 0.05), negative estrogen receptor (ER) expression (P < 0.05), and smaller size of tumors (P < 0.05). After adjusting for age and BMI, the risk of developing secondary diabetes and IFG in subjects with later pathological stage BC (hazard ratio (HR) = 1.623; 95 % confidence interval (CI) 1.128-2.335 (P < 0.01)), negative progesterone receptor (PR) expression (HR = 0.530; 95 % CI 0.372-0.755 (P < 0.001)), positive human epidermal growth factor receptor 2 (HER2) expression (HR = 1.822; 95 % CI 1.230-2.700 (P < 0.01)), and more lymph node metastasis (HR = 1.595; 95 % CI 1.128-2.258 (P < 0.01)) was significantly higher. In conclusion, this study shows that an increase in the incidence of diabetes among breast cancer survivors after systemic therapy, especially the patients with later pathological stages, more lymph node metastasis, negative hormone receptor expression, and positive HER2 expression. Our study suggests that greater diabetes screening and prevention strategies among breast cancer patients after systemic treatment are needed in China.
authors: Department of Breast and Thyroid Surgery, Wuhan University, Renmin Hospital, Wuhan, 430060, China.
authors: Li
authors: L
authors: Juanjuan
authors: Department of Breast and Thyroid Surgery, Wuhan University, Renmin Hospital, Wuhan, 430060, China.
authors: Wei
authors: W
authors: Wen
authors: Department of Breast and Thyroid Surgery, Wuhan University, Renmin Hospital, Wuhan, 430060, China.
authors: Liu
authors: L
authors: Zhongfen
authors: Department of Breast and Thyroid Surgery, Wuhan University, Renmin Hospital, Wuhan, 430060, China.
authors: Chen
authors: C
authors: Chuang
authors: Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
authors: Cheng
authors: C
authors: Jing
authors: Department of Breast Surgery, Hubei Cancer University, Wuhan, 430079, China.
authors: Gong
authors: G
authors: Yiping
authors: Department of Pathology and Pathophysiology, Wuhan University School of Basic Medical Sciences, Wuhan, 430071, China.
authors: Wang
authors: W
authors: Changhua
authors: Department of Breast and Thyroid Surgery, Wuhan University, Renmin Hospital, Wuhan, 430060, China.
authors: Yu
authors: Y
authors: Dehua
authors: Department of Breast and Thyroid Surgery, Wuhan University, Renmin Hospital, Wuhan, 430060, China. sun137@sina.com.
authors: Sun
authors: S
authors: Shengrong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose; D001943:Breast Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D002681:China; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000139:chemically induced / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D011379:Prognosis
chemical_list: D001786:Blood Glucose
keywords: Breast cancer; Clinical features; Pathological features; Systemic therapy; Type 2 diabetes