Relationship Between Blood Glucose And Endocrine Resistance In Luminal Subtype Breast Cancer

Objective:Breast cancer is one of the most common malignant tumors in women,withhormonereceptor-positivetypesaccountingfor approximately 75%.However,up to 50%of patients develop endocrine resistance and it is important to find out factors that predict endocrine resistance.Studies have shown that hyperglycemia significantly increases the risk of breast cancer morbidity and mortality compared with normal blood glucose.Impaired glucose tolerance worsens the prognosis of breast cancer.This study reviewed the clinical data of 194 patients with Luminal breast cancer,analyzed the relationship between blood glucose and clinical characteristics,endocrine resistance and prognosis in order to provide a basis for improving the prognosis of breast cancer and overcoming endocrine resistance.Methods:194 cases of female Luminal patients were collected in Hebei General Hospital,who underwent modified radical mastectomy,all pathologies were infiltrating ductal carcinoma.The factors of the patients were collected and classified,including age,menstrual status,pathological type,clinical stage,lymph node metastasis,vascular tumor embolus,and BMI,Luminal subtype classification,the mean value of two fasting blood glucose values.The patients with fasting blood glucose?6.1mmol/L were divided into higher blood glucose group and<6.1mmol/L group into normal blood glucose group.Taking patient's operative time as the starting point,patient develops endocrine resistance,loss of visit or up to February 28th 2017 as the end point.A median follow-up was 25 months ranging from 14 to 60 months.Recurrence,distant metastasis during regular use of endocrine drugs after modified radical mastectomy and normative adjuvant treatment is defined as endocrine therapy resistance.The statistical software of SPSS version20.0 was used for data processing,and the relationship between blood glucose and clinicopathological features in patients was analyzed by?~2test or Fisher's exact probability method.Disease-free survival rate in different Blood glucose groups was analyzed by Kaplan-Meier method.Log rank test difference of disease-free survival rate between both goups.Cox regression model was used to analyze the influence of every factor on endocrine resistance,and to explore the independent risk factors of endocrine resistance in breast cancer.Results:1.The proportion of patients of higher blood glucose group in age<50 and?50 was 12.0%(9/75)and 25.2%(30/119),respectively.The differencebetweenthetwogroupswasstatistically significant(?~2=4.998,P=0.025).The proportion of patients of higher blood glucose group in BMI<24 and?24 groups was 5.4%(2/37)and23.6%(37/157),respectively.The difference between the two groups was statistically significant(?~2=6.149,P=0.013).The proportion of patients of higher blood glucose group in PR positive group and PR negative group were 17.5%(30/171)and 39.1%(9/23),respectively.The difference between the two groups was statistically significant(?~2=5.882,P=0.015).Hyperglycemia was not associated with menstrual status,lymph node metastasis,vascular tumor embolus,clinical stage and Luminal subtype.2.The resistance rates of 1,3,5 years in the higher blood glucose group were7.7%,41.0%,53.8%,respectively.The resistance rates of 1,3,5 years in the normal blood glucose group were 0.0%,23.9%,27.1%,respectively.The difference between the two groups was statistically significant(?~2=9.193,P=0.002).3.In the analysis of COX regression model,the whole model test had statistical significance.The hazard ratio and 95%confidence interval of blood glucose,lymph node metastasis were 1.196(1.068,1.340)?1.923(1.009,3.665),P=0.002,0.047,respectively,P<0.05.Conclusions:1.Blood glucose is associated with age,BMI,and progesterone receptor expression,but not related to menstrual state,lymph node metastasis,vascular tumor embolus,clinical stage,and Luminal subtype in patients with Luminal type breast cancer.2.Blood glucose,lymph node metastasis is an independent risk factor for endocrine resistance in patients with Luminal subtype after modified radical mastectomy.3.Poor blood glucose control(?6.1 mmol/L)suggests poor prognosis of endocrine therapy in patients with Luminal subtype breast cancer.