癌症合并糖尿病患者应用糖皮质激素安全性的前瞻性随机对照研究

目的：从循证医学的角度探讨癌症合并糖尿病的患者使用糖皮质激素（glucorticoids，GC）是否安全。方法：有糖尿病史或治疗前发现糖尿病者进入糖尿病组，无糖尿病史治疗前空腹血糖高于正常但未达到糖尿病诊断标准者进入空腹血糖损害（impaired fasting glucose，IFG）组，通过计算机随机筛选出最适合与实验组配对者作为对照组。GC及化疗根据需要按常规选择，定期测定全部患者的静脉血糖、糖尿病患者和IFG患者的毛细血管血糖，前瞻性评价GC治疗后的血糖变化、不良反应及其影响因素。结果：糖尿病组患者29例，使用GC后恶心呕吐、腹部不适、头痛、失眠、肺炎、多汗、心慌及血压升高的比例高于对照组，但均无统计学意义。接受GC治疗期间，只有1例（3％）血糖正常，28例（97％）有1次以上血糖升高，显著高于对照组，t=6．309，P=0．000。但均在可以控制且不影响肿瘤治疗及GC治疗的范围内。对照组患者有5例（17％）血糖高于正常，其中1例血糖有4次血糖高于正常。入院前未接受降糖治疗的糖尿病患者。需要改变降糖措施的比例（2／11）高于入院前已接受降糖治疗的糖尿病患者（2／18）和IFG患者（2／24），但差异无统计学意义，F=0．73，P=0．694。IFG组24例，与糖尿病组有类似的结果。入院血糖正常的220例患者中，化疗后20例空腹血糖升高（9．09％）。未化疗仅使用LH者34例，4例空腹血糖升高（11．76％），无统计学意义。但在化疗患者中，不同的化疗方案影响血糖升高的发生率。NP方案治疗后发生空腹血糖升高的比例为34．61％，高于CAF（4．76％）、FLP（4．76％）、EP（3．70％）等治疗方案。结论：癌症患者伴发糖尿病及IFG的比例远高于一般人群，但常规应用GC是安全的。血糖正常患者化疗同时使用GC，个别化疗药物、年龄、地塞米松日剂量和病期影响空腹血糖升高的发生率。     

顺铂为基础的联合化疗对非小细胞肺癌患者血糖影响的临床观察

目的:探讨顺铂(DDP)为基础的联合化疗在非小细胞性肺癌(NSCLC)治疗中对血糖变化的影响.方法:以顺铂为基础的联合化疗患者150例,回顾性分析化疗前后的血糖变化情况及相关临床资料.结果:150例患者中,化疗期间6例(4.00%)确诊为糖尿病(DM),6例(4.00%)出现糖耐量减低(IGT),10例(6.67%)出现空腹血糖受损(IFG),8例(5.33%)一过性血糖升高,继发DM患者化疗前后的平均血糖值分别为(5.08±0.18)和(10.79±2.80)mmol/L,化疗前后空腹血糖水平差异有统计学意义,t=5.200,P=0.003.继发DM多发生在化疗的第3.5个周期,DDP的累积量约280 mg/m2.结论:常规剂量顺铂化疗能引起DM、IGT、IFG及一过性血糖升高,化疗期间应密切监测血糖.     

恶性肿瘤化疗患者糖化血红蛋白和空腹血糖的观察

目的:观察化疗对恶性肿瘤患者糖化血红蛋白和空腹血糖的影响。方法:49例恶性肿瘤患者(无糖尿病史者44例,有糖尿病史者5例),检测每周期化疗前及首次化疗后糖化血红蛋白及空腹血糖,对所得数据及相关临床资料进行分析。结果:无糖尿病组化疗后发生高血糖23例(52.3%),糖化血红蛋白升高12例(27.3%),确诊糖尿病10例(22.7%)。糖尿病组化疗后发生高血糖及高糖化血红蛋白4例。合并糖尿病组、无糖尿病组首次化疗后糖化血红蛋白水平较化疗前均有升高(P=0.035,P=0.0000968),无糖尿病组第2、7、8次化疗前糖化血红蛋白值较未化疗时显著升高(P=0.005,P=0.014,P=0.001),第4次化疗前空腹血糖较未化疗时显著升高(P=0.04)。结论:化疗可导致部分恶性肿瘤患者糖化血红蛋白和空腹血糖升高;空腹血糖联合糖化血红蛋白可以帮助确诊潜在的糖尿病患者。     

紫杉类化疗方案治疗乳腺癌继发糖尿病的相关分析

目的:观察紫杉类方案化疗对乳腺癌患者血糖的影响。方法:回顾性分析我院2009年1月-2013年6月收治的215例乳腺癌患者化疗前后的血糖变化情况及相关临床资料。结果:化疗期间出现继发性糖尿病15例（15/215,6.98%）,化疗后出现继发性糖尿病9例（9/215,4.19%）,其年龄均大于50岁;19例出现空腹血糖调节受损（19/215,8.84%）,其中化疗期间出现12例（12/215,5.58%）,化疗后出现7例（7/215,3.26%）; 1例继发性糖尿病患者血糖控制不好因酮症酸中毒而于化疗后10个月死亡（1/24,4.17%）,19例空腹血糖调节受损患者中经过饮食控制及物理治疗11例空腹血糖水平恢复到正常水平（11/19,57.89%）。结论:乳腺癌患者应用紫杉类化疗方案化疗与继发性糖尿病或空腹血糖调节受损之间存在一定的相关性。     

多西他赛对乳腺癌患者糖代谢的影响

目的 探讨多西他赛对乳腺癌患者糖代谢的影响.方法 124例经术后病理证实的女性乳腺癌患者术后均接受含多西他赛方案化疗,化疗前均已排除血糖异常及糖尿病,观察每周期化疗前后血糖及糖化血红蛋白变化.结果 全部124例患者均按计划完成6周期化疗.化疗后有11例(8.87％)空腹血糖升高,24例(19.35％)糖耐量减低;其中诊断为2型糖尿病者8例(6.45％),一过性血糖增高5例(4.03％).结论 乳腺癌接受含多西他赛方案化疗后可能引起血糖增高、糖耐量减低,甚至2型糖尿病,化疗期间应密切监测血糖及糖化血红蛋白水平,及时干预治疗.     

5-氟尿嘧啶为基础的联合化疗对结直肠癌患者血糖代谢的影响

目的:观察结直肠癌患者接受以5-氟尿嘧啶(5-fluorouracil, 5-FU)为基础的联合化疗前和化疗期间血糖水平的变化,探讨5-FU与患者发生糖尿病(diabetes mellitus, DM)之间的关系.方法:采用回顾性方法分析97例接受含5-FU方案化疗的结直肠癌患者在化疗前和化疗期间空腹血糖的变化.结果: 剔除化疗前罹患DM的3例患者、空腹血糖受损的3例患者以及糖耐量异常的1例患者,对剩余的化疗前空腹血糖正常的90例患者进行分析.其中,化疗期间继发DM者5例(5/90,5.56%),继发空腹血糖损伤者16例(16/90,17.78%),继发糖耐量损伤者1例(1/90,1.11%).5例继发DM的患者在化疗前以及化疗期间出现继发DM时的平均空腹血糖分别为(4.95±0.31)和(12.20±6.23) mmol/L,化疗后空腹血糖水平明显高于化疗前空腹血糖水平(P＜0.01);继发DM时的中位5-FU累积剂量为7 500 mg/m2,至DM时的中位化疗周期数为2个;其中4例患者有糖皮质激素注射史,继发DM时的中位地塞米松累积剂量为25 mg;继发DM患者中有1例死于DM酮症酸中毒.16例继发空腹血糖损伤的患者中,12例患者在化疗结束2～7个月后空腹血糖恢复至正常,其余4例仍维持空腹血糖损伤状态,短期随访无一例演变为DM.结论:以5-FU为基础的化疗可诱使结直肠癌患者继发DM,甚至可引起DM酮症酸中毒.部分患者出现一过性空腹血糖受损.     

恶性肿瘤患者780例医院感染的调查与分析

目的:分析了解恶性肿瘤医院感染的发病情况,找出医院感染相关因素,为临床防治提供依据。方法:对2001年9月~2002年9月住院的恶性肿瘤患者按统一设计的调查项目进行调查,分析总结。结果:恶性肿瘤患者医院感染率为8·5%,明显高于同期其他住院患者的感染率3·83%,P<0·001;感染部位以上呼吸道(39·39%)为主,其次为下呼吸道(30·30%),胃肠道(18·18%),泌尿道(4·55%);感染率随年龄增高而增加,随住院时间延长而延长;医院感染患者中共检出细菌35株,其中革兰氏阴性菌占57·20%,革兰氏阳性菌占17·1%,真菌占25·71%。结论:医院感染随年龄的增长,住院周期的延长而增加。放、化疗综合者其感染率显著高于单一治疗,两者间差异有统计学意义,P<0·001。     

DF方案加卡莫氟联合放疗治疗食管癌的临床分析

探讨DF方案加卡莫氟联合放疗治疗食管癌的疗效和毒副反应。将76例食管癌患者随机分为两组行前瞻性临床研究。综合组38例行DF方案化疗后常规放疗,放疗同时口服卡莫氟;单放组38例行单纯放疗。放疗采用8MV X线常规照射,DT60~70Gy。两个组均随访满3年。综合组1、2和3年生存率(81·1%、68·3%和57·2%)明显高于单放组(74·2%、50·1%和27·4%),P=0·0225;且无严重毒副反应。两组的局部控制率差异有统计学意义,P=0·0143。初步研究结果提示,DF方案加卡莫氟化疗联合放射治疗食管癌疗效较好。     

非霍奇金淋巴瘤合并糖尿病患者的治疗体会

 目的 探讨非霍奇金淋巴瘤合并糖尿病患者的激素使用问题。方法 对40例合并糖尿病的非霍奇金淋巴瘤患者用含泼尼松（PDN）的方案进行化疗，比较使用PDN前后的血糖变化，调整降糖药物，同时观察并发症。结果 患者入院时空腹血糖（6.1±1.3）mmol／L，化疗后血糖（6.5±1.2）mmol／L，化疗前后血糖比较差异无统计学意义；化疗过程中降糖药用量略增加；所有患者无并发症发生。结论 在有效控制血糖的情况下，非霍奇金淋巴瘤合并糖尿病的患者可常规使用PDN。     

无糖尿病病史的乳腺癌患者系统治疗后糖耐量异常状况研究

  目的  通过口服葡萄糖耐量试验(OGTT)了解无糖尿病病史的乳腺癌患者系统治疗后糖耐量异常状况。  方法  对121例系统治疗(手术治疗和/或化疗)结束后3个月以上无糖尿病病史的乳腺癌患者行OGTT检测, 检测空腹及OGTT餐后2 h血糖值以明确此类患者有无伴随糖耐量异常, 同期6例有糖尿病病史的乳腺癌患者未行OGTT检测。  结果  患者平均随访年龄为50.4岁, 系统治疗后平均随访时间为19个月。在121例无糖尿病病史的乳腺癌患者中:糖尿病(即未知晓糖尿病)和糖尿病前期发生率分别为19.8%(24/121)和45.5%(55/121), 糖耐量相对正常仅占34.7%(42/121);在所有127例系统治疗后的乳腺癌患者中已知晓糖尿病、未知晓糖尿病及糖尿病前期发生率分别为4.72%(6/127)、18.9%(24/127)和43.3%(55/127), 其中糖尿病的未知晓率高达80%。约80%的糖尿病及74.5%糖尿病前期的诊断需经OGTT餐后2 h血糖检测确诊而非空腹血糖检测。  结论  系统治疗后的乳腺癌患者存在明显的糖代谢紊乱, 伴有高比例的未知晓糖尿病和糖尿病前期, 对此类患者建议行OGTT检测, 以利于早期诊断和防治糖尿病的发生, 改善预后。      

化疗对恶性肿瘤合并糖尿病40例血糖的影响

[目的]探讨恶性肿瘤合并糖尿病患者化疗前后血糖的变化。[方法]检测40例恶性肿瘤合并糖尿病患者化疗前后血糖的变化。[结果]40例患者完成预计的化疗周期数,12例患者化疗期间出现高血糖（〉14.0mmol/L）,其中3例血糖高于27.8mmol/L,尿酮体阳性;3例患者出现低血糖反应;6例患者均对症处理后好转。化疗期间及化疗后血糖均较化疗前显著升高（P〈0.01）。[结论]化疗可导致恶性肿瘤合并糖尿病患者血糖进一步升高,尤其发生在化疗前血糖升高的患者。     

Type 2 diabetes mellitus and prognosis in early stage breast cancer women

It has been suggested that type 2 diabetes mellitus may affect breast cancer prognosis, possibly due to increased diabetes-related comorbidity, or direct effects of insulin resistance and/or hyperinsulinemia. The aim of this study was to determine the impact of diabetes on disease-free survival (DFS) following mastectomy for breast cancer patients. The cases included in this retrospective study were selected from breast cancer women who had undergone mastectomy and completed adjuvant chemotherapy from 1998 to 2010. Patients were classified into two groups: diabetic and non-diabetic. Patients' age, sex, menopausal status, body mass index (BMI), histopathological features, tumor size, lymph node involvement, hormone receptor and HER2-neu status, and treatment types were recorded. There were 483 breast cancer patients included in the study. Postmenopausal patients' rate (53.7% vs. 36.8%, P = 0.016) and mean BMI levels were statistically higher (32.2 vs. 27.9, P = 0.007) in diabetic patients. There was no statistical difference for histological subgroup, grade, ER and PR positivity, HER2-neu overexpression rate, and tumor size between the diabetic and non-diabetic group. Lymph node involvements were statistically higher in diabetic patients compared with non-diabetic patients (P = 0.013). Median disease-free survival is 81 months (95% CI, 61.6-100.4) in non-diabetic patients and 36 months (95% CI, 13.6-58.4) in diabetic patients (P < 0.001). The odds ratio of recurrence was significantly increased in those with HER2-neu overexpression and lymph node involvement and decreased with PR-positive tumors. Our results suggest that diabetes is an independent prognostic factor for breast cancer.     

Non-alcoholic Fatty Liver Disease (NAFLD) and Significant Hepatic Fibrosis Defined by Non-invasive Assessment in Patients with Type 2 Diabetes

Background: Non-alcoholic fatty liver disease (NAFLD), the most common liver problem in diabetes, is arisk factor for liver cancer. Diabetes, high body mass index (BMI) and old age can all contribute to NAFLDprogression. Transient elastography (TE) is used for non-invasive fibrosis assessment. Objectives: To identifythe prevalence of NAFLD and significant hepatic fibrosis in diabetic patients and to assess associated factors.Materials and Methods: One hundred and forty-one diabetic and 60 normal subjects were screened. Fatty liverwas diagnosed when increased hepatic echogenicity and vascular blunting were detected by ultrasonography.Liver stiffness measurement (LSM) representing hepatic fibrosis was assessed by TE. LSM ≥7 kPa was used todefine significant hepatic fibrosis. Results: Four cases were excluded due to positive hepatitis B viral markersand failed TE. Diabetic patients had higher BMI, systolic blood pressure, waist circumference and fasting glucoselevels than normal subjects. Fatty liver was diagnosed in 82 (60.7%) diabetic patients but in none of the normalgroup. BMI (OR: 1.31; 95%CI: 1.02-1.69; p=0.038) and alanine aminotransferase (ALT)(OR: 1.14; 95%CI:1.05-1.23; p=0.002) were associated with NAFLD. Diabetic patients with NAFLD had higher LSM than thosewithout [5.99 (2.4) vs 4.76 (2.7) kPa, p=0.005)]. Significant hepatic fibrosis was more common in diabetic patientsthan in normal subjects [22 (16.1%) vs 1 (1.7%), p=0.002]. Aspartate aminotransferase (AST)(OR: 1.24; 95%CI:1.07-1.42; p=0.003) was associated with significant hepatic fibrosis. Conclusions: Sixty and sixteen percent ofdiabetic patients were found to have NAFLD and significant hepatic fibrosis. High BMI and ALT levels are thepredictors of NAFLD, and elevated AST level is associated with significant hepatic fibrosis.     

Glycated hemoglobin and cancer incidence and mortality in the Atherosclerosis in Communities (ARIC) Study, 1990-2006

Diabetes is a risk factor for many cancers; chronic hyperglycemia is hypothesized to be, in part, explanatory. We evaluated the association between glycated hemoglobin, a time-integrated glycemia measure, and cancer incidence and mortality in nondiabetic and diabetic men and women. We conducted a prospective study of 12,792 cancer-free participants attending the second visit (1990-1992) of the Atherosclerosis Risk in Communities (ARIC) Study. We measured glycated hemoglobin in whole-blood samples using HPLC. Incident cancers were ascertained from registries and hospital records through 2006. We estimated multivariable-adjusted hazard ratios (HR) of cancer incidence and mortality for nondiabetic participants with values ≥ 5.7% (elevated), nondiabetic participants with <5.0% (low) and diabetic participants all compared with nondiabetic participants with 5.0-5.6% (normal). We ascertained 2,349 incident cancer cases and 887 cancer deaths. Compared with nondiabetic women with normal glycated hemoglobin, nondiabetic women with elevated values had an increased risk of cancer incidence (HR:1.24; 95% CI:1.07,1.44) and mortality (HR:1.58; 95% CI:1.23,2.05) as did diabetic women (incidence, HR:1.30; 95% CI:1.06,1.60, mortality, HR:1.96; 95% CI:1.40,2.76). Nondiabetic women with low values also had increased risk. Diabetic women with good glycemic control (<7.0%) had a lower cancer risk than those with higher values. Glycated hemoglobin in nondiabetic and diabetic men, and diabetes were not statistically significantly associated with total cancer risk. Our findings support the hypothesis that chronic hyperglycemia, even in the nondiabetic range, increases cancer risk in women. Maintaining normal glycated hemoglobin overall, and good glycemic control among diabetic adults, may reduce the burden of cancer, especially in women.     

The effects of diabetes and fasting plasma glucose on treatment of breast cancer with neoadjuvant chemotherapy

PurposeTo determine the effects of diabetes and fasting plasma glucose (FPG) level on the pathologic response in patients with breast cancer who received neoadjuvant chemotherapy.MethodsOne hundred and thirty-five patients files who received neoadjuvant chemotherapy between 2013 and 2017 years, were scanned. Pathologic responses, diabetes, and FPG dates of patients were reached from archive files. Patients were grouped as diabetic and nondiabetic.ResultsPatients with higher than 90% pathologically response according to Miller-Payne grading system, constituted 11 (44%) and 61 (55.5%) of patients; patients with equally or lower than 90% pathologically response were 14 (56%) and 49 (44.5%) and the number of patients with nonpathologic response 5 (20%) and 2 (1.8%) in diabetic and nondiabetic group, respectively. This difference between diabetic and nondiabetic groups was statistically significant (P = 0.005). In Miller-Payne groups, the median FPG levels were 135 mg/dl (165.6 ± 86.5), 96 mg/dl (110.0 ± 30.6), 97 mg/dl (101.9 ± 23.9), 91.5 mg/dl (102.5 ± 44.3) and 93.5 mg/dl (112.0 ± 61.2) respectively 0%, 1%-30%, 31%-90%, 91%-99%, and 100%. Patients with lower 91% pathologic response had statistically significant higher FPG levels compared with patients with higher patholocig response (P = 0.008). The cut-of FPG value to determine nonpathologic response was calculated 105 mg/dl (sensitivity 85.7% specificity 74.2%). The FPG, diabetes, lymph node positivity, and disease stage were statistically significant in the multivariate analysis for affecting non-pathologic response (P = 0.013, P = 0.016, P = 0.036, and P = 0.035 respectively).ConclusionDiabetes and high FPG level may be predictive to the non-response of neoadjuvant chemotherapy in patients with breast cancer.     

Chemotherapy-Induced Neuropathy and Diabetes: A Scoping Review

Although cancer and diabetes are common diseases, the relationship between diabetes, neuropathy and the risk of developing peripheral sensory neuropathy while or after receiving chemotherapy is uncertain. In this review, we highlight the effects of chemotherapy on the onset or progression of neuropathy in diabetic patients. We searched the literature in Medline and Scopus, covering all entries until 31 January 2021. The inclusion and exclusion criteria were: (1) original article (2) full text published in English or Spanish; (3) neuropathy was specifically assessed (4) the authors separately analyzed the outcomes in diabetic patients. A total of 259 papers were retrieved. Finally, eight articles fulfilled the criteria, and four more articles were retrieved from the references of the selected articles. The analysis of the studies covered the information about neuropathy recorded in 768 cancer patients with diabetes and 5247 control cases (non-diabetic patients). The drugs investigated are chemotherapy drugs with high potential to induce neuropathy, such as platinum derivatives and taxanes, which are currently the mainstay of treatment of various cancers. The predisposing effect of co-morbid diabetes on chemotherapy-induced peripheral neuropathy depends on the type of symptoms and drug used, but manifest at any drug regimen dosage, although greater neuropathic signs are also observed at higher dosages in diabetic patients. The deleterious effects of chemotherapy on diabetic patients seem to last longer, since peripheral neuropathy persisted in a higher proportion of diabetic patients than non-diabetic patients for up to two years after treatment. Future studies investigating the risk of developing peripheral neuropathy in cancer patients with comorbid diabetes need to consider the duration of diabetes, cancer-induced neuropathic effects per se (prior chemotherapy administration), and the effects of previous cancer management strategies such as radiotherapy and surgery.     

全脑照射加Vm-26治疗肺癌脑转移临床研究

目的观察Vm-26配合全脑放疗与单纯放疗治疗肺癌脑转移的疗效、生存时间及不良反应。方法将60例肺癌脑转移患者随机分为单纯放疗组(放疗组30例)和放化疗综合组(综合组30例)。放疗组全脑常规放疗40Gy/4周。综合组放疗方法与单纯放疗组相同,放疗第1天开始给药,Vm-2660mg/m2,1次/周。结果放疗组和综合组总有效率分别为80.0%(24/30)和83.3%(25/30)。治疗后中位生存时间放疗组为5.4个月,综合组为7.6个月。两组中位生存时间比较差异有统计学意义,Z=2.365,P=0.0180,综合组骨髓抑制和胃肠反应高于放疗组,但大部分患者能耐受。结论肺癌脑转移患者全脑放疗加Vm-26可以延长生存时间。     

可手术的乳腺癌术前化疗的远期效果

目的探讨术前化疗对可手术的乳腺癌的远期疗效。方法可手术的乳腺癌患者５３７例,分为两组：术前化疗组（Ａ组）２５３例;术后辅助化疗组（Ｂ组）２８４例。Ａ组术前联合化疗,每周一次共４次,休２周行根治性手术。两组患者术后两周内开始化疗、化疗方案和完成化疗周期相同。结果（１）Ⅲ期患者,Ａ组５年总生存率（ＯＳ）５９％,无病存活率（ＤＦＳ）５４．９％,均明显高于Ｂ组２８．３％和２０．８％（Ｐ＜０．０５）。（２）Ⅱ期患者,Ａ组８年ＯＳ８１．４％,ＤＦＳ７６．３％,均高于Ｂ组６７．４％和６２．９％（Ｐ＜０．０５）。Ⅲ期患者,Ａ组８年ＯＳ４６．９％,ＤＦＳ４０．６％,也高于Ｂ组２０．７％和１３．３％（Ｐ＜０．０５）。（３）Ａ组Ｔ３、Ｔ４和转移淋巴结数≥４个的患者,５年、８年生存率均高于Ｂ组（Ｐ＜０．０５）。结论可手术的Ⅲ期乳腺癌,术前化疗可提高患者５年、８年生存率,明显改善Ⅱ期患者的远期疗效。     

Glucose metabolism disorders in cancer patients in a Chinese population

Background Characteristics of glucose metabolism disorders (GMDs) in different cancers and the contributory role of GMDs in developing cancers are still not so clear. Methods Two thousand four hundred and five patients with malignancy who had been hospitalized in the First Affiliated Hospital of Jinan University were pooled as case group. Two thousand and sixteen non-cancer people who finished health examinations in the Affiliated Yangcheng Hospital of Guangzhou Medical College were enrolled as control group. We compared glucose metabolism among patients with different kinds of malignancy. Based on logistic regression models, we analyzed factors that affect the development of carcinoma. Results (1) Among 2,408 malignancy patients, the total prevalence of diabetes mellitus (DM) and impaired fasting glucose (IFG) reached 28.0%. Pancreatic cancer, lymphoma, liver cancer, leukemia, and colorectal cancer showed most striking hyperglycemia. (2) Leukemia and esophageal cancer accounting for 12.5% and 12.1%, respectively, were the most likely to suffer from hypoglycemia. (3) Older cancer patients seem to be more vulnerable to hyperglycemia, while the younger tend to be more likely to develop hypoglycemia. (4) High level of fasting plasma glucose (FPG) was associated with lung cancer, breast cancer, leukemia, lymphoma, thyroid cancer, bladder cancer, and pancreatic cancer. Patients with DM increased risks for developing colorectal cancer, liver cancer, esophageal cancer, thyroid cancer, cervical cancer, and pancreatic cancer. Conclusions GMDs are frequent events in malignancy patients. Hyperglycemia and hypoglycemia are found in the same kinds or different kinds of cancers, and the incidence of hyperglycemia is higher than that of hypoglycemia. Characteristics of GMDs were dissimilar in different cancers and different ages. Hyperglycemia was a risk factor for many cancers.     

Clinical features and molecular phenotypes of breast cancer in patients with type-2 diabetes mellitus

Objective: To investigate the clinical features, molecular phenotypes and clinical prognosis of breast cancer patients with type-2 diabetes mellitus, thereby providing a basis for individualized therapy of breast cancer. Methods: 105 breast cancer patients with type-2 diabetes mellitus (DM) presenting from January 2005 to December 2010 were enrolled in this study. 200 breast cancer non-diabetic patients in the same period were randomly selected as the control group. The clinical data of DM group and control group were retrospectively analyzed. The SPSS12.0 software was used for statistics and survival analysis. Results: The mean age of the patients in DM group were of 57.2±11.8 years, which was older compared with the control group. The percentage of postmenopausal patients was 71.4% and the ratio of grade II+III was 98.8%, which was higher than the control group. The neoadjuvant chemotherapy response rate of DM group was 67.5%, which was lower than control group. The patients in DM group had later clinical stage and more lymph metastasis. The proportion of advanced breast cancer was 68.57% and the ratio of lymph node metastasis was 66.01%. All the difference was significant (P<0.05). But there was no significant difference in tumor size and molecular phenotype between the diabetic group with breast cancer and the control group. Disease-free survival and overall survival rates of DM group were 80.2% and 84.2%, which were worse than those in the control group. All the difference was significant (P<0.05). After excluding the patients with other causes of death, results of overall survival still showed worse in DM group, but the difference was not statistically significant(P>0.05). Serum insulin at fasting and two hours postprandial were higher than normal value in DM group, but serum insulin levels in the control group changed in the normal range. Conclusion: There were older patients, with a higher proportion of high pathological grade, more lymph node metastasis, later clinical stages in the diabetic group with breast cancer. Breast cancer patients with type-2 diabetes mellitus were at risk of a poor prognosis. Hyperinsulinemia may be the real cause of poor prognosis in breast cancer patients with type-2 diabetes.