1
|
Kim J, Lee HI, Kim IA, Lee JH, Cho J, Wee CW, Yoon HI. De Ritis ratio in elderly glioblastoma patients treated with chemoradiation: A comprehensive analysis of serum biomarkers. Neurooncol Adv 2024; 6:vdad173. [PMID: 38288092 PMCID: PMC10824161 DOI: 10.1093/noajnl/vdad173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024] Open
Abstract
Background We aimed to comprehensively investigate the prognostic value of pretreatment laboratory parameters in elderly patients with glioblastoma treated with temozolomide (TMZ)-based chemoradiation. Methods Patients aged ≥ 65 years from 4 institutions with newly diagnosed IDH-wild-type glioblastoma who received radiotherapy (RT) with concurrent TMZ between 2006 and 2021 were included. Patient factors (age, Karnofsky performance status (KPS), temporalis muscle thickness), molecular factors (MGMT promoter methylation, EGFR amplification, TERT promoter mutation, and TP53 mutation status), treatment factors (extent of resection, and RT dose), and pretreatment laboratory parameters (serum De Ritis ratio, glucose level, neutrophil-to-lymphocyte ratio, platelet count, and systemic immune-inflammation index) were included in the analysis. The primary endpoint was overall survival (OS). Results In total, 490 patients were included in the analysis. The median follow-up period was 12.3 months (range, 1.6-149.9 months). Median OS was significantly prolonged in patients with De Ritis ratio < 1.2 (18.2 vs 15.3 months, P = .022) and in patients with glucose level < 150 mg/dL (18.7 vs 16.5 months, P = .034) per univariate analysis. In multivariate analysis, KPS ≥ 70, MGMT promoter methylation, extent of resection greater than partial resection, De Ritis ratio < 1.2, and glucose level < 150 mg/dL were significant prognostic factors for improved OS. Conclusions Along with well-known prognostic factors, pre-RT serum biomarkers, including the De Ritis ratio and glucose level, also had prognostic value in elderly patients with glioblastoma treated with TMZ-based chemoradiation.
Collapse
Affiliation(s)
- Jina Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hye In Lee
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Radiation Oncology, Asan Medical Center, Seoul, Korea
| | - In Ah Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Joo Ho Lee
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jaeho Cho
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Chan Woo Wee
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiation Oncology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hong In Yoon
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
2
|
Mohammadbeigy I, Khalilian MS, Najafizadeh N, Moazam E, Hemati S, Zeinalian M. The role of serum lipid profile, fasting blood sugar, and body mass index on recurrence and metastasis in patients with estrogen receptor-positive breast cancer: A case-control study. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2023; 28:83. [PMID: 38292335 PMCID: PMC10826846 DOI: 10.4103/jrms.jrms_163_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/11/2023] [Accepted: 04/27/2023] [Indexed: 02/01/2024]
Abstract
Background Breast cancer (BC) is the leading cause of cancer death in women. The current study is designed to evaluate the association of lipid profiles, FBS, and body mass index (BMI) with BC recurrence and metastasis. Materials and Methods This is a case-control study on estrogen receptor-positive BC patients in Isfahan Province, Central Iran, between 2008 and 2020. The control group was patients who had no evidence of recurrence or metastasis at least 1 year after the end of chemotherapy and hormone therapy. The case group was patients with evidence of metastasis or recurrence within 1 year after the end of chemotherapy and hormone therapy. Fasting blood sugar (FBS), total cholesterol (Chol), triglyceride (TG), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) were measured before treatment, after chemotherapy, and after hormone therapy as well as BMI in the case and control groups. Results There were 108 patients in the case and 119 patients in the control group with a mean age of 50.72 ± 13.26 and 51.91 ± 11.79, respectively. There were no meaningful differences between the case and control groups regarding serum FBS, Chol, TG, HDL, LDL, and BMI. Conclusion We found no association between serum FBS, lipid profile, and BMI at initial diagnosis and BC recurrence or metastasis.
Collapse
Affiliation(s)
- Iman Mohammadbeigy
- Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Sadegh Khalilian
- Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nadia Najafizadeh
- Department of Radiation Oncology, Seyed Al-Shohada (Omid) Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
- Cancer Prevention Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elham Moazam
- Cancer Prevention Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Simin Hemati
- Department of Radiation Oncology, Seyed Al-Shohada (Omid) Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
- Cancer Prevention Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehrdad Zeinalian
- Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Cancer Prevention Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Iranian Cancer Control Center (MACSA), Isfahan, Iran
| |
Collapse
|
3
|
Jara Fornerod M, Alvarez-Fernandez A, Michalska M, Papakonstantinou I, Guldin S. Glucose Oxidase Loading in Ordered Porous Aluminosilicates: Exploring the Potential of Surface Modification for Electrochemical Glucose Sensing. CHEMISTRY OF MATERIALS : A PUBLICATION OF THE AMERICAN CHEMICAL SOCIETY 2023; 35:7577-7587. [PMID: 37780408 PMCID: PMC10536975 DOI: 10.1021/acs.chemmater.3c01202] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/22/2023] [Indexed: 10/03/2023]
Abstract
Enzymatic electrochemical sensors have become the leading glucose detection technology due to their rapid response, affordability, portability, selectivity, and sensitivity. However, the performance of these sensors is highly dependent on the surface properties of the electrode material used to store glucose oxidase and its ability to retain enzymatic activity under variable environmental conditions. Mesoporous thin films have recently attracted considerable attention as promising candidates for enzyme storage and activity preservation due to their well-defined nanoarchitecture and tunable surface properties. Herein, we systematically compare pathways for the immobilization of glucose oxidase (GOx) and their effectiveness in electrochemical glucose sensing, following modification protocols that lead to the electrostatic attraction (amino functionalization), covalent bonding (aldehyde functionalization), and electrostatic repulsion (oxygen plasma treatment) of the ordered porous aluminosilicate-coated electrodes. By direct comparison using a quartz crystal microbalance, we demonstrate that glucose oxidase can be loaded in a nanoarchitecture with a pore size of ∼50 nm and pore interconnections of ∼35 nm using the native aluminosilicate surface, as well as after amino or aldehyde surface modification, while oxygen plasma exposure of the native surface inhibits glucose oxidase loading. Despite a variety of routes for enzyme loading, quantitative electrochemical glucose sensing between 0 and 20 mM was only possible when the porous surface was functionalized with amino groups, which we relate to the role of surface chemistry in accessing the underlying substrate. Our results highlight the impact of rational surface modification on electrochemical biosensing performance and demonstrate the potential of tailoring porous nanoarchitecture surfaces for biosensing applications.
Collapse
Affiliation(s)
| | - Alberto Alvarez-Fernandez
- Department
of Chemical Engineering, University College
London, Torrington Place, London WC1E 7JE, U.K.
| | - Martyna Michalska
- Department
of Electronic & Electrical Engineering, University College London, Torrington Place, London WC1E 7JE, U.K.
| | - Ioannis Papakonstantinou
- Department
of Electronic & Electrical Engineering, University College London, Torrington Place, London WC1E 7JE, U.K.
| | - Stefan Guldin
- Department
of Chemical Engineering, University College
London, Torrington Place, London WC1E 7JE, U.K.
| |
Collapse
|
4
|
Liao Y, Huang J, Chen H, Li S, Chen C, Lin F, Yang Z. The association between fasting blood glucose and prognosis in gastrointestinal stromal tumor patients after curable resection. Updates Surg 2023:10.1007/s13304-023-01500-z. [PMID: 36997825 DOI: 10.1007/s13304-023-01500-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 03/22/2023] [Indexed: 04/01/2023]
Abstract
Blood glucose has been demonstrated to serve as prognostic indicators in various malignancies. This study aimed to explore the relationship between fasting blood glucose (FBG) levels and the prognosis in patients with gastrointestinal stromal tumor (GIST) undergoing complete resection. Data were retrospectively collected from 256 patients with primary GIST underwent complete surgical resection or endoscopic excision. Patients were stratified into euglycemic group and hyperglycemic group. Patients' characteristics between groups were compared. Cox regression model was conducted to identify independent prognostic factors of disease-free survival (DFS). Both univariate analysis and multivariate analyses revealed that FBG ≥ 100 mg/dl was associated with poor outcomes. Patients with FBG ≥ 100 mg/dl tended to have more adverse features, more likely to suffer recurrence and a worse 5-year DFS than patients with FBG < 100 mg/dl. Moreover, FBG levels helped distinguishing between patients with different survival outcomes in different risk categories defined by modified NIH systems. Our data provided the evidence that FBG is a useful prediction marker prognosis in patients with GIST undergoing curative surgery.
Collapse
Affiliation(s)
- Yi Liao
- Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, GD510655, People's Republic of China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, GD510655, People's Republic of China
| | - Jintuan Huang
- Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, GD510655, People's Republic of China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, GD510655, People's Republic of China
| | - Hao Chen
- Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, GD510655, People's Republic of China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, GD510655, People's Republic of China
| | - Senmao Li
- Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, GD510655, People's Republic of China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, GD510655, People's Republic of China
| | - Chunyu Chen
- Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, GD510655, People's Republic of China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, GD510655, People's Republic of China
| | - Feng Lin
- Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, GD510655, People's Republic of China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, GD510655, People's Republic of China
| | - Zuli Yang
- Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, GD510655, People's Republic of China.
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, GD510655, People's Republic of China.
| |
Collapse
|
5
|
Chan DS, Vieira R, Abar L, Aune D, Balducci K, Cariolou M, Greenwood DC, Markozannes G, Nanu N, Becerra‐Tomás N, Giovannucci EL, Gunter MJ, Jackson AA, Kampman E, Lund V, Allen K, Brockton NT, Croker H, Katsikioti D, McGinley‐Gieser D, Mitrou P, Wiseman M, Cross AJ, Riboli E, Clinton SK, McTiernan A, Norat T, Tsilidis KK. Postdiagnosis body fatness, weight change and breast cancer prognosis: Global Cancer Update Program (CUP global) systematic literature review and meta-analysis. Int J Cancer 2023; 152:572-599. [PMID: 36279884 PMCID: PMC10092239 DOI: 10.1002/ijc.34322] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 07/29/2022] [Accepted: 09/05/2022] [Indexed: 02/01/2023]
Abstract
Previous evidence on postdiagnosis body fatness and mortality after breast cancer was graded as limited-suggestive. To evaluate the evidence on body mass index (BMI), waist circumference, waist-hip-ratio and weight change in relation to breast cancer prognosis, an updated systematic review was conducted. PubMed and Embase were searched for relevant studies published up to 31 October, 2021. Random-effects meta-analyses were conducted to estimate summary relative risks (RRs). The evidence was judged by an independent Expert Panel using pre-defined grading criteria. One randomized controlled trial and 225 observational studies were reviewed (220 publications). There was strong evidence (likelihood of causality: probable) that higher postdiagnosis BMI was associated with increased all-cause mortality (64 studies, 32 507 deaths), breast cancer-specific mortality (39 studies, 14 106 deaths) and second primary breast cancer (11 studies, 5248 events). The respective summary RRs and 95% confidence intervals per 5 kg/m2 BMI were 1.07 (1.05-1.10), 1.10 (1.06-1.14) and 1.14 (1.04-1.26), with high between-study heterogeneity (I2 = 56%, 60%, 66%), but generally consistent positive associations. Positive associations were also observed for waist circumference, waist-hip-ratio and all-cause and breast cancer-specific mortality. There was limited-suggestive evidence that postdiagnosis BMI was associated with higher risk of recurrence, nonbreast cancer deaths and cardiovascular deaths. The evidence for postdiagnosis (unexplained) weight or BMI change and all outcomes was graded as limited-no conclusion. The RCT showed potential beneficial effect of intentional weight loss on disease-free-survival, but more intervention trials and well-designed observational studies in diverse populations are needed to elucidate the impact of body composition and their changes on breast cancer outcomes.
Collapse
Affiliation(s)
- Doris S.M. Chan
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Rita Vieira
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Leila Abar
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Dagfinn Aune
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- Department of NutritionBjørknes University CollegeOsloNorway
- Department of Endocrinology, Morbid Obesity and Preventive MedicineOslo University HospitalOsloNorway
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | - Katia Balducci
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Margarita Cariolou
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Darren C. Greenwood
- Leeds Institute for Data Analytics, Faculty of Medicine and HealthUniversity of LeedsLeedsUK
| | - Georgios Markozannes
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- Department of Hygiene and EpidemiologyUniversity of Ioannina Medical SchoolIoanninaGreece
| | - Neesha Nanu
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Nerea Becerra‐Tomás
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Edward L. Giovannucci
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Department of Nutrition, Harvard T. H. Chan School of Public HealthBostonMassachusettsUSA
| | - Marc J. Gunter
- Nutrition and Metabolism Section, International Agency for Research on CancerLyonFrance
| | - Alan A. Jackson
- Faculty of Medicine, School of Human Development and HealthUniversity of SouthamptonSouthamptonUK
- National Institute of Health Research Cancer and Nutrition CollaborationSouthamptonUK
| | - Ellen Kampman
- Division of Human Nutrition and HealthWageningen University & ResearchWageningenThe Netherlands
| | - Vivien Lund
- World Cancer Research Fund InternationalLondonUK
| | - Kate Allen
- World Cancer Research Fund InternationalLondonUK
| | | | - Helen Croker
- World Cancer Research Fund InternationalLondonUK
| | | | | | | | | | - Amanda J. Cross
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Elio Riboli
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Steven K. Clinton
- Division of Medical Oncology, The Department of Internal MedicineCollege of Medicine and Ohio State University Comprehensive Cancer Center, Ohio State UniversityColumbusOhioUSA
| | - Anne McTiernan
- Division of Public Health SciencesFred Hutchinson Cancer Research CenterSeattleWashingtonUSA
| | - Teresa Norat
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- World Cancer Research Fund InternationalLondonUK
| | - Konstantinos K. Tsilidis
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- Department of Hygiene and EpidemiologyUniversity of Ioannina Medical SchoolIoanninaGreece
| |
Collapse
|
6
|
Gioseffi C, Padilha PDC, Chaves GV, de Oliveira LC, Peres WAF. Body Weight, Central Adiposity, and Fasting Hyperglycemia Are Associated with Tumor Characteristics in a Brazilian Cohort of Women with Breast Cancer. Nutrients 2022; 14:nu14224926. [PMID: 36432611 PMCID: PMC9698342 DOI: 10.3390/nu14224926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/12/2022] [Accepted: 11/16/2022] [Indexed: 11/23/2022] Open
Abstract
The aim of this study was to evaluate the association of overweight, obesity, excess central adiposity, hyperglycemia, and diabetes mellitus with tumor characteristics in breast cancer. In this retrospective cohort study that enrolled 2127 women with breast cancer, the independent variables collected were fasting blood glucose, body mass index, central adiposity (waist circumference and waist-to-hip circumference ratio (WHR)), and waist-to-height ratio. The tumor characteristics (infiltrating, ductal grade, hormone receptor-positive (HR+), human epidermal growth factor receptor, triple negative, size, lymph node involvement, and clinical stage) were the dependent variables. Most of the women were postmenopausal (73.5%), with an infiltrating tumor (83.0%), HR+ (82.0%), and overweight or obese (71.0%). For the premenopausal women, obesity was associated with grade 3 ductal tumor (odds ratio (OR): 1.70; 95% confidence interval (95% CI): 1.09-2.66), triple negative (OR: 1.37, 95% CI: 1.08-3.24), and size ≥ 2 cm (OR: 2.20, 95% CI: 1.36-3.56). For the postmenopausal women, obesity was associated with WHR, infiltrating tumor (OR: 1.73, 95% CI: 1.56-1.95), size ≥ 2 cm (OR: 1.38, 95% CI: 1.11-1.71), lymph node involvement (OR: 1.24, 95% CI: 1.02-1.56), and stages III-IV (OR: 1.76, 95% CI: 1.30-2.65). Excess body weight and central adiposity were associated with tumor aggressiveness characteristics in women with breast cancer, confirming the importance of nutritional status.
Collapse
Affiliation(s)
- Clara Gioseffi
- José Alencar Gomes da Silva National Cancer Institute (INCA), Rio de Janeiro 20560-120, Brazil
| | - Patricia de Carvalho Padilha
- Department of Nutrition and Dietetics, Josué de Castro Nutrition Institute, Health Science Center, Campus Fundão, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil
| | - Gabriela Villaça Chaves
- José Alencar Gomes da Silva National Cancer Institute (INCA), Rio de Janeiro 20560-120, Brazil
| | - Livia Costa de Oliveira
- José Alencar Gomes da Silva National Cancer Institute (INCA), Rio de Janeiro 20560-120, Brazil
| | - Wilza Arantes Ferreira Peres
- Department of Nutrition and Dietetics, Josué de Castro Nutrition Institute, Health Science Center, Campus Fundão, Federal University of Rio de Janeiro, Rio de Janeiro 21941-902, Brazil
- Correspondence:
| |
Collapse
|
7
|
Yilmaz H, Nigdelioglu B, Aytac A, Turan M, Oktay E, Yersal O, Barutca S. The prognostic importance of glucose-to-lymphocyte ratio and uric acid in metastatic breast cancer patients treated with Cdk 4/6 inhibitors. Future Oncol 2022; 18:3043-3053. [PMID: 36062468 DOI: 10.2217/fon-2022-0464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim: To demonstrate the prognostic importance of glucose-to-lymphocyte ratio (GLR) and uric acid (UA) in patients with metastatic breast cancer (MBC) receiving Cdk 4/6 inhibitors. Materials & methods: Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, GLR, UA and CA15-3 were analyzed to assess their prognostic value using Kaplan-Meier curves and Cox regression analysis in 101 patients with MBC, retrospectively. Results: Importantly, both progression-free survival and overall survival were shorter in the group with high neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), GLR and UA. In the multivariate analysis, GLR and UA levels were independent prognostic factors for both progression-free survival and overall survival. Conclusion: In patients with MBC, GLR and UA are independent factors that predict survival times.
Collapse
Affiliation(s)
- Hatice Yilmaz
- 1Department of Medical Oncology, Adnan Menderes University Faculty of Medicine, Aydın, Turkey
| | - Büsra Nigdelioglu
- 1Department of Medical Oncology, Adnan Menderes University Faculty of Medicine, Aydın, Turkey
| | - Ali Aytac
- 1Department of Medical Oncology, Adnan Menderes University Faculty of Medicine, Aydın, Turkey
| | - Merve Turan
- 1Department of Medical Oncology, Adnan Menderes University Faculty of Medicine, Aydın, Turkey
| | - Esin Oktay
- 1Department of Medical Oncology, Adnan Menderes University Faculty of Medicine, Aydın, Turkey
| | - Ozlem Yersal
- 1Department of Medical Oncology, Adnan Menderes University Faculty of Medicine, Aydın, Turkey
| | - Sabri Barutca
- 1Department of Medical Oncology, Adnan Menderes University Faculty of Medicine, Aydın, Turkey
| |
Collapse
|
8
|
Abrahamsen O, Balslev E, Christensen M, Wibrand F, Budtz‑jørgensen E, Høgdall E. The impact of metabolic supply lines ‑ and the patterns between them‑on the development of distant metastases in 64 women with breast cancer. Oncol Lett 2022; 24:327. [PMID: 35966346 PMCID: PMC9366742 DOI: 10.3892/ol.2022.13447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 07/07/2022] [Indexed: 11/06/2022] Open
Abstract
Cancer cells upregulate their metabolism to underlie the increased malignant activity. This requires an increased amount of ‘metabolic building materials’, for example glucose, amino acids etc., which have the blood circulation as their principal supply lines. Targeting these metabolic supply lines, and thus the availability of metabolic building materials in the blood, therefore carries treatment potential. A central observation is that the malignant alterations comprise great complexity and that compensatory mechanisms exist. Therefore, targeted supply lines should presumably constitute specific patterns to achieve therapeutic effect. The aim of the present study was to investigate if such patterns could be seen to correlate with the development of distant metastases. The study was conducted using a case-cohort design. In total, 64 women diagnosed with breast cancer between January 2011 and December 2015 were included. Among these, 32 had developed distant metastases and 32 had not. From a blood sample drawn at the time of diagnosis, the levels of glucose (HbA1c), glutamine, arginine and cystathionine were measured. Cox regression was applied to investigate the impact of the supply lines of these ‘building materials’ and specifically the patterns between them on the development of distant metastases. The results demonstrate a significant impact of the investigated metabolic supply lines, centrally in relation to interaction between them and in relation to the impact of the increased cumulated utilization of multiple supply lines simultaneously. In conclusion, the results indicated that the metabolic supply lines may impact clinical outcome, and, in this regard, the results placed a substantial emphasis on the effect of the patterns between these supply lines.
Collapse
Affiliation(s)
- Oliver Abrahamsen
- Department of Pathology, Molecular Unit, Herlev Hospital, University of Copenhagen, 2730 Herlev, Denmark
| | - Eva Balslev
- Department of Pathology, Molecular Unit, Herlev Hospital, University of Copenhagen, 2730 Herlev, Denmark
| | - Mette Christensen
- Department of Clinical Genetics, Metabolic Laboratory, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Flemming Wibrand
- Department of Clinical Genetics, Metabolic Laboratory, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Esben Budtz‑jørgensen
- Department of Public Health, Section of Biostatistics, University of Copenhagen, 1353 Copenhagen, Denmark
| | - Estrid Høgdall
- Department of Pathology, Molecular Unit, Herlev Hospital, University of Copenhagen, 2730 Herlev, Denmark
| |
Collapse
|
9
|
Guo Z, Wang J, Tian X, Fang Z, Gao Y, Ping Z, Liu L. Body mass index increases the recurrence risk of breast cancer: a dose-response meta-analysis from 21 prospective cohort studies. Public Health 2022; 210:26-33. [PMID: 35868141 DOI: 10.1016/j.puhe.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 05/09/2022] [Accepted: 06/13/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the effect of body mass index (BMI) on the recurrence risk of breast cancer. STUDY DESIGN Dose-response meta-analysis. METHODS Cohort studies that included BMI and the recurrence of breast cancer were selected through various databases including PubMed, Web of Science, the China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals (VIP), and Wanfang Data Knowledge Service Platform (WanFang) until November 30, 2021. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of literature. A two-stage random-effects meta-analysis was performed to assess the dose-response relationship between BMI and breast cancer recurrence risk. Heterogeneity between studies is assessed using I2. RESULTS The relative risk (RR) of BMI <25 kg/m2 vs BMI ≥25 kg/m2, BMI <30 kg/m2 vs BMI ≥30 kg/m2 were 1.09 (95% CI: 1.00-1.19) and 1.15 (95% CI: 1.04-1.27), suggesting that BMI had a significant effect on the recurrence risk of breast cancer, and there might be a dose-response relationship between them. A total of 21 studies were included in dose-response meta-analysis, which showed that there was a positive linear correlation between BMI and the risk of recurrence (RR = 1.02, 95% CI: 1.01-1.03). For every 1 kg/m2 increment of BMI, the risk of recurrence increased by approximately 2%. In subgroup analyses, positive linear dose-response relationships between BMI and recurrence risk were observed among Asian and study period >10 years groups. For every 1 kg/m2 increment of BMI, the risk of recurrence increased by 3.41% and 1.87%, respectively. CONCLUSIONS The recurrence risk of breast cancer increases with BMI, which is most obvious among Asian women.
Collapse
Affiliation(s)
- Z Guo
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, China.
| | - J Wang
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, China.
| | - X Tian
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, China.
| | - Z Fang
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, China.
| | - Y Gao
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, China.
| | - Z Ping
- College of Public Health, Zhengzhou University, Zhengzhou, Henan, China.
| | - L Liu
- School of Basic Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China.
| |
Collapse
|
10
|
Pang Y, Wei Y, Kartsonaki C. Associations of adiposity and weight change with recurrence and survival in breast cancer patients: a systematic review and meta-analysis. Breast Cancer 2022; 29:575-588. [PMID: 35579841 PMCID: PMC9226105 DOI: 10.1007/s12282-022-01355-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 03/23/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Adiposity and weight change among patients with breast cancer are associated with mortality, but there is limited evidence on the associations with distant recurrence or other causes of death or on central adiposity. Moreover, the relationship with breast cancer subtypes and by menopause status is unclear. METHODS We conducted a systematic review and meta-analysis of prospective studies of breast cancer patients investigating the associations of general and central adiposity (body mass index [BMI] and waist circumference [WC], respectively), before and after diagnosis, and weight change, with all-cause mortality, breast cancer-specific mortality (BCSM), and recurrence. RESULTS 173 studies (519,544 patients, 60,249 deaths overall, and 25,751 breast cancer deaths) were included. For BMI < 1 year post diagnosis, compared with normal weight women, the summary relative risk (RR) for obese women was 1.21 (1.15-1.27) for all-cause mortality, 1.22 (1.13-1.32) for BCSM, 1.12 (1.06-1.18) for recurrence, and 1.19 (1.11-1.28) for distant recurrence. Obesity was associated with all-cause mortality and BCSM in patients with ER+ or HER2+ tumors, whereas no clear association was observed in patients with triple-negative tumors. Similar associations were observed by menopausal status. Stronger associations were observed in East Asians than Europeans. Central adiposity was associated with all-cause mortality, while large weight gain was associated with all-cause mortality, BCSM, and recurrence. CONCLUSION Higher adiposity is associated with all-cause mortality, BCSM, recurrence, and distant recurrence in breast cancer patients, with similar associations by menopausal status and some evidence of heterogeneity by subtypes. Weight gain is also associated with recurrence and survival among breast cancer patients.
Collapse
Affiliation(s)
- Yuanjie Pang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Beijing, 100191, China
| | - Yuxia Wei
- Institute of Environmental Medicine, Karolinska Institutet, C6 Institutet för miljömedicin, 17177, Stockholm, Sweden
| | - Christiana Kartsonaki
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Big Data Institute Building, Roosevelt Drive, Oxford, UK.
- Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Big Data Institute Building, Old Road Campus, Oxford, OX3 7LF, UK.
| |
Collapse
|
11
|
Liu HP, Wei JCC, Yip HT, Yeh MH. Association of Insomnia, Depressive Disorders, and Mood Disorders as Risk Factors With Breast Cancer: A Nationwide Population-Based Cohort Study of 232,108 Women in Taiwan. Front Oncol 2021; 11:757626. [PMID: 34707998 PMCID: PMC8542844 DOI: 10.3389/fonc.2021.757626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background Insomnia, depressive disorders, and to a more general view, mood disorders are raising people’s concerns and causing disability of life. Herein, we try to seek the association of such illnesses with subsequent breast cancer. Methods This population-based, retrospective cohort study used data from the Taiwan National Health Insurance Research Database. This study included 232,108 women diagnosed with insomnia, depressive disorders, and mood disorders from January 1, 2000 to December 31, 2013. Physician diagnosed insomnia, depressive disorders, or mood disorders using outpatient and inpatient records before diagnosis of breast cancer. Cox proportional hazards regression analysis is adjusted for women with insomnia, depressive disorders, mood disorders, and other factors like insured amount, urbanization, and comorbidities such as having subsequent breast cancer. Results Sleep medication was associated with a significantly increased incidence rate of breast cancer (aHR = 1.23 (95% CI = 1.13, 1.35), p < 0.001). Insomnia was associated with significant increased hazard of breast cancer (aHR = 1.16 (95% CI = 1.07, 1.27), p < 0.001). Annual insured amount >20,000 (TWD), high urbanization area, and hyperlipidemia were associated with increased hazard of breast cancer (aHR = 1.13 (95% CI = 1.01, 1.27), p = 0.04; aHR = 1.41 (95% CI = 1.17, 1.71), p < 0.001; aHR = 1.14 995% CI = 1.02, 1.29), p = 0.02, respectively). There was a positive correlation between depressive disorders and increased incidence rate of breast cancer but not statistically significant (aHR = 1.11 (95% CI = 0.99, 1.25), p = 0.08). Mood disorders were not associated with increased hazard (aHR = 1.11 (95% CI = 0.91, 1.34), p = 0.31). Conclusion In this study, women with insomnia had increased risk of breast cancer, particularly those in high urbanization or with high insured amounts. Sleep medication (benzodiazepine (BZD) or non-BZD) and hyperlipidemia were independently associated with a higher hazard ratio of breast cancer. Insomnia along with sleep medication did not yield more hazards than each alone. Mood disorders appeared to be not associated with subsequent breast cancer. However, depressive disorders, the subgroups of mood disorders, could possibly increase the incidence rate of breast cancer though not statistically significant.
Collapse
Affiliation(s)
- Hui-Pu Liu
- Department of General Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - James Cheng-Chung Wei
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan.,Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Hei-Tung Yip
- Management Office for Health Data, Clinical Trial Research Center, China Medical University Hospital, Taichung, Taiwan
| | - Ming-Hsin Yeh
- Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan
| |
Collapse
|
12
|
Postoperative Fasting Blood Glucose Predicts Prognosis in Stage I-III Colorectal Cancer Patients Undergoing Resection. Gastroenterol Res Pract 2020; 2020:2482409. [PMID: 32382263 PMCID: PMC7199537 DOI: 10.1155/2020/2482409] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/25/2019] [Accepted: 12/28/2019] [Indexed: 12/12/2022] Open
Abstract
Purpose The relationship between high blood glucose and colorectal cancer (CRC) has been studied, but the role of postoperative fasting blood glucose (FBG) in patients with a prior normal FBG has never been addressed. Methods A total of 120 CRC patients staged I-III were enrolled, and the prognostic value of postoperative FBG for disease-free survival (DFS) was determined by Kaplan-Meier analysis. Univariate and multivariate analyses were conducted to test other clinicopathological parameters, including preoperative hemoglobin (HGB) and the neutrophil-lymphocyte ratio (NLR). Results By a cut-off point of 5.11 mmol/L, 51 and 69 patients were divided into low postoperative FBG (<5.11 mmol/L) and high postoperative FBG (≥5.11 mmol/L) groups, respectively. A high postoperative FBG was more common in older age (P = 0.01), left-located tumor (P = 0.02), smaller tumor diameter (P = 0.01), node negative involvement (P = 0.01), lesser positive lymph nodes (P = 0.02), and high preoperative HGB (P = 0.01). Further, high postoperative FBG patients displayed a significantly better DFS than low postoperative FBG patients (48.80 ± 22.12 months vs. 40.06 ± 24.36 months, P = 0.04), but it was less likely to be an independent prognostic factor. Conclusions Postoperative FBG plays a temporal prognostic role for patients with stage I-III CRC with a prior normal FBG, but it is not an independent prognostic factor.
Collapse
|
13
|
Glucose to Lymphocyte Ratio as a Prognostic Marker in Patients With Resected pT2 Gallbladder Cancer. J Surg Res 2019; 240:17-29. [PMID: 30909062 DOI: 10.1016/j.jss.2019.02.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/31/2019] [Accepted: 02/22/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND We designed a clinical application of glucose to lymphocyte ratio (GLR) as it might be a sensitive parameter to determine the glucose metabolism and behavior of the cancer (i.e., its aggressiveness), and the immunologic status of a patient with cancer. Thus, we investigated the association of GLR with the overall survival (OS) and disease-free survival (DFS) of patients with T2 gallbladder (GB) cancer after curative-intent surgery. METHODS The medical records of patients with T2 GB cancer who underwent surgery were retrospectively reviewed. The clinicopathologic characteristics, preoperative complete blood counts, fasting blood glucose, albumin, cholesterol, and follow-up information were collected. RESULTS A total of 197 patients were included in the study. In multivariate analysis, high GLR (>69.3) was associated with poor OS (HR = 15.249, 95% CI: 4.090-56.849, P = 0.0001) along with R1 status (HR = 1.755, 95% CI: 0.033-0.910, P = 0.033), >3 metastatic lymph nodes (HR = 2.809, 95% CI: 1.403-5.625; P = 0.004), and lymphovascular invasion (HR = 8.041, 95% CI: 2.881-22.442; P = 0.0001). Moreover, high GLR (HR = 3.666, 95% CI: 1.145-11.737, P = 0.029), adjuvant chemotherapy (HR = 6.306, 95% CI: 1.921-20.699; P = 0.002), lymphovascular invasion (HR = 5.464, 95% CI: 1.783-16.746; P = 0.003), and high-grade tumor (HR = 2.143, 95% CI: 1.042-4.407; P = 0.038) were independently associated with DFS. CONCLUSIONS Preoperative GLR is an independent predictor of OS and DFS in T2 GB cancer. Further studies are required to validate these findings.
Collapse
|
14
|
Zhu F, Xu X, Shi B, Zeng L, Wang L, Wu X, Zhu H. The positive predictive value of low-density lipoprotein for recurrence-free survival in ovarian cancer. Int J Gynaecol Obstet 2018; 143:232-238. [PMID: 30112762 DOI: 10.1002/ijgo.12645] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 06/15/2018] [Accepted: 08/13/2018] [Indexed: 01/03/2023]
Affiliation(s)
- Fangfang Zhu
- Department of Gynecology; the First Affiliated Hospital of Wenzhou Medical University; Wenzhou China
| | - Xinxin Xu
- Department of Gynecology; the First Affiliated Hospital of Wenzhou Medical University; Wenzhou China
| | - Beibei Shi
- Department of Gynecology; the First Affiliated Hospital of Wenzhou Medical University; Wenzhou China
| | - Linchai Zeng
- Department of Gynecology; the First Affiliated Hospital of Wenzhou Medical University; Wenzhou China
| | - Luhui Wang
- Department of Clinical Medicine; Jiaxing University; Jiaxing China
| | - Xueqing Wu
- Department of Gynecology; the First Affiliated Hospital of Wenzhou Medical University; Wenzhou China
| | - Haiyan Zhu
- Department of Gynecology; the First Affiliated Hospital of Wenzhou Medical University; Wenzhou China
| |
Collapse
|
15
|
Borniger JC, Walker Ii WH, Surbhi, Emmer KM, Zhang N, Zalenski AA, Muscarella SL, Fitzgerald JA, Smith AN, Braam CJ, TinKai T, Magalang UJ, Lustberg MB, Nelson RJ, DeVries AC. A Role for Hypocretin/Orexin in Metabolic and Sleep Abnormalities in a Mouse Model of Non-metastatic Breast Cancer. Cell Metab 2018; 28:118-129.e5. [PMID: 29805100 PMCID: PMC6031468 DOI: 10.1016/j.cmet.2018.04.021] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 01/08/2018] [Accepted: 04/29/2018] [Indexed: 12/21/2022]
Abstract
We investigated relationships among immune, metabolic, and sleep abnormalities in mice with non-metastatic mammary cancer. Tumor-bearing mice displayed interleukin-6 (IL-6)-mediated peripheral inflammation, coincident with altered hepatic glucose processing and sleep. Tumor-bearing mice were hyperphagic, had reduced serum leptin concentrations, and enhanced sensitivity to exogenous ghrelin. We tested whether these phenotypes were driven by inflammation using neutralizing monoclonal antibodies against IL-6; despite the reduction in IL-6 signaling, metabolic and sleep abnormalities persisted. We next investigated neural populations coupling metabolism and sleep, and observed altered activity within lateral-hypothalamic hypocretin/orexin (HO) neurons. We used a dual HO-receptor antagonist to test whether increased HO signaling was causing metabolic abnormalities. This approach rescued metabolic abnormalities and enhanced sleep quality in tumor-bearing mice. Peripheral sympathetic denervation prevented tumor-induced increases in serum glucose. Our results link metabolic and sleep abnormalities via the HO system, and provide evidence that central neuromodulators contribute to tumor-induced changes in metabolism.
Collapse
Affiliation(s)
- Jeremy C Borniger
- Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Neuroscience Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Behavioral Neuroendocrinology Group, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
| | - William H Walker Ii
- Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Neuroscience Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Behavioral Neuroendocrinology Group, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
| | - Surbhi
- Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Neuroscience Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Behavioral Neuroendocrinology Group, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Kathryn M Emmer
- Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Neuroscience Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Behavioral Neuroendocrinology Group, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Department of Veterinary Preventative Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Ning Zhang
- Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Neuroscience Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Behavioral Neuroendocrinology Group, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Abigail A Zalenski
- Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Neuroscience Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Behavioral Neuroendocrinology Group, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Stevie L Muscarella
- Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Neuroscience Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Behavioral Neuroendocrinology Group, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Julie A Fitzgerald
- Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Neuroscience Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Behavioral Neuroendocrinology Group, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Alexandra N Smith
- Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Neuroscience Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Behavioral Neuroendocrinology Group, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Cornelius J Braam
- Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Neuroscience Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Behavioral Neuroendocrinology Group, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Tial TinKai
- Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Neuroscience Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Behavioral Neuroendocrinology Group, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Ulysses J Magalang
- Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Neuroscience Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Maryam B Lustberg
- Comprehensive Cancer Center, Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Randy J Nelson
- Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Neuroscience Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Behavioral Neuroendocrinology Group, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - A Courtney DeVries
- Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Neuroscience Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; Behavioral Neuroendocrinology Group, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| |
Collapse
|
16
|
Simon JM, Thomas F, Czernichow S, Hanon O, Lemogne C, Simon T, Pannier B, Danchin N. Hyperglycaemia is associated with cancer-related but not non-cancer-related deaths: evidence from the IPC cohort. Diabetologia 2018; 61:1089-1097. [PMID: 29305626 DOI: 10.1007/s00125-017-4540-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 12/01/2017] [Indexed: 12/11/2022]
Abstract
AIMS/HYPOTHESIS Hyperglycaemia has been associated with the incidence of all and specific types of cancer, distinct from the risks related to diabetes. The relationships between blood glucose and mortality rates related to all and specific cancers were analysed in comparison with all-cause or non-cancer-related mortality rates in a large, general primary care population in France. METHODS Between January 1991 and December 2008, 301,948 participants (193,221 men and 108,727 women), aged 16-95 years (mean ± SD 44.8 ± 12.0 years for men and 45.1 ± 14.2 years for women), had a health check at the IPC Centre. All data collected in standard conditions during the health checks-up were used for statistical analysis All examinations were performed under fasting conditions and included a blood glucose measurement. Participants with known diabetes (<9%) were excluded from the analysis. Participants were classified into quintiles based on their blood glucose measurement and were followed for a maximum of 17 years (mean ± SD 9.2 ± 4.7 years) to assess all-cause, cancer and non-cancer mortality rates. RESULTS A non-linear relationship was observed between cancer mortality rates and blood glucose quintile after adjustment for age and sex. There was a significant association between the group with the highest blood glucose level and cancer-related death (multivariate Cox model, HR [95% CI] 1.17 [1.03, 1.34]), while the group with normoglycaemia showed no association with cancer-related deaths. We did not observe a relationship between blood glucose and all-cause or non-cancer mortality rates. An excess risk of death was observed in the highest blood glucose quintile for gastrointestinal cancer and leukaemia. Adjustments for diabetes and aspirin use did not modify the results. However, this excess risk disappeared with use of glucose-lowering agents (HR [95% CI] 1.03 [0.74, 1.43]). CONCLUSIONS/INTERPRETATION Hyperglycaemia is associated with significantly higher rates of cancer-related deaths, particularly in gastrointestinal cancer and leukaemia, but not with non-cancer-related deaths. The association is retained when taking into account confounding factors, including chronic aspirin treatment.
Collapse
Affiliation(s)
- Jean-Marc Simon
- Centre IPC, 6-14 rue La Pérouse, 75016, Paris, France
- Hopital Pitié Salpétrière, APHP, Paris, France
| | | | - Sebastien Czernichow
- Hopital HEGP, APHP, Paris, France
- Hôpitaux Universitaires Paris Ouest, APHP, Paris, France
| | - Olivier Hanon
- Centre IPC, 6-14 rue La Pérouse, 75016, Paris, France
- Hopital Broca, APHP, Paris, France
| | - Cedric Lemogne
- Hopital HEGP, APHP, Paris, France
- Hôpitaux Universitaires Paris Ouest, APHP, Paris, France
- Inserm U894, Centre Psychiatrie et Neurosciences, Paris, France
| | - Tabassome Simon
- Hopital Saint Antoine, APHP, Université Pierre et Marie Curie, Paris, France
| | - Bruno Pannier
- Centre IPC, 6-14 rue La Pérouse, 75016, Paris, France.
- Hopital Manhès, Fleury-Merogis, France.
| | - Nicolas Danchin
- Centre IPC, 6-14 rue La Pérouse, 75016, Paris, France
- Hopital HEGP, APHP, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, Paris, France
| |
Collapse
|
17
|
Abstract
Purpose: Breast is the leading site of cancer onset and death in Italy. Cases diagnosed in stage IV or that progress in metastatic phase represent a specific and challenging task for oncologists. Estimates on the burden of breast cancer (BC) in stage IV in Italy are not available. Methods: We applied mortality-incidence age-specific ratios measured in the United States in 2013 for BC in stage IV at diagnosis (de novo) or following a previous diagnosis in a localized stage (distant recurrence) to the age-specific BC deaths observed in Italy in 2014. The US mortality-prevalence age-specific ratios were used for estimating de novo and distant recurrence prevalent metastatic BC. Results: In 2014 in Italy, there were 12,330 deaths due to BC. We estimated that in the same year about 3400 BC were newly diagnosed in stage IV (7.1% of all the new cases); moreover, more than 10,000 other BC progressed to stage IV. In addition, in 2014, the overall number of BC in stage IV, whenever diagnosed, was about 37,100 (5.6% of all the estimated prevalent BC). Conclusions: These estimates quantify, for the first time in Italy, the burden of BC in stage IV, at diagnosis or during the clinical course, providing useful figures for clinicians and policy makers.
Collapse
Affiliation(s)
- Emanuele Crocetti
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRCS) IRCCS, Meldola, Italy
| | - Stefania Gori
- Associazione Italiana Oncologia Medica, Milan, Italy
- Cancer Care Center “Sacro Cuore-Don Calabria,” Negrar, Italy
| | - Fabio Falcini
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRCS) IRCCS, Meldola, Italy
- Azienda USL della Romagna, Forlì, Italy
| |
Collapse
|
18
|
Vernieri C, Nichetti F, Raimondi A, Pusceddu S, Platania M, Berrino F, de Braud F. Diet and supplements in cancer prevention and treatment: Clinical evidences and future perspectives. Crit Rev Oncol Hematol 2018; 123:57-73. [DOI: 10.1016/j.critrevonc.2018.01.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 01/11/2018] [Indexed: 12/14/2022] Open
|
19
|
Lafourcade A, His M, Baglietto L, Boutron-Ruault MC, Dossus L, Rondeau V. Factors associated with breast cancer recurrences or mortality and dynamic prediction of death using history of cancer recurrences: the French E3N cohort. BMC Cancer 2018; 18:171. [PMID: 29426294 PMCID: PMC5807734 DOI: 10.1186/s12885-018-4076-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 01/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In addition to tumor characteristics and lifestyle factors, cancer relapses are often related to the risk of death but have not been jointly studied. We investigate the prognostic factors of recurrent events and death after a diagnosis of breast cancer and predict individual deaths including a history of recurrences. METHODS The E3N (Etude Epidémiologique auprès de Femmes de la Mutuelle Générale de l'Education Nationale) study is a prospective cohort study that was initiated in 1990 to investigate factors associated with the most common types of cancer. Overall survival and three types of recurrent events were considered: locoregional recurrence, metastasis, and second primary breast cancer. Recurrent events and death were analyzed using a joint frailty model. RESULTS The analysis included 4926 women from the E3N cohort diagnosed with a first primary invasive breast cancer between June 1990 and June 2008; during the follow-up, 1334 cases had a recurrence (median time of follow-up is 7.2 years) and 469 women died. Cases with high grade, large tumor size, axillary nodal involvement, and negative estrogen and progesterone receptors had a higher risk of recurrence or death. Furthermore, smoking increased the risk of relapse. For cases with a medium risk profile in terms of tumor characteristics and lifestyle factors, the probability of dying between 5 and 10 years after diagnosis was 6, 20 and 36% for 0, 1 or 2 recurrences within the first 5 years after diagnosis, respectively. CONCLUSIONS Our study showed the importance of considering baseline lifestyle characteristics and history of relapses to dynamically predict the risk of death in breast cancer cases. Medical experience coupled with an estimate of a patient's survival probability that considers all available information for this patient would enable physicians to make better informed decisions regarding their actions and thus improve clinical output.
Collapse
Affiliation(s)
- Alexandre Lafourcade
- Research Center Inserm, U1219 Bordeaux, France
- University of Bordeaux, Bordeaux, France
| | - Mathilde His
- CESP Generations and Health Team, Paris-Saclay University, Paris-Sud Univ, UVSQ, INSERM, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Laura Baglietto
- CESP Generations and Health Team, Paris-Saclay University, Paris-Sud Univ, UVSQ, INSERM, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Marie-Christine Boutron-Ruault
- CESP Generations and Health Team, Paris-Saclay University, Paris-Sud Univ, UVSQ, INSERM, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Laure Dossus
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - Virginie Rondeau
- Research Center Inserm, U1219 Bordeaux, France
- University of Bordeaux, Bordeaux, France
- Biostatistic Team, INSERM U1219, University of Bordeaux, 146 rue Léo Saignat, CS 61292, F-33076 Bordeaux Cedex, France
| |
Collapse
|
20
|
Min JY, Min KB. Insulin resistance and the increased risk for smell dysfunction in US adults. Laryngoscope 2018; 128:1992-1996. [DOI: 10.1002/lary.27093] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 11/25/2017] [Accepted: 12/20/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Jin-Young Min
- Institute of Health and Environment; Seoul National University; Seoul Republic of Korea
| | - Kyoung-Bok Min
- Department of Preventive Medicine, Colleague of Medicine; Seoul National University; Seoul Republic of Korea
| |
Collapse
|
21
|
Buono G, Crispo A, Giuliano M, De Angelis C, Schettini F, Forestieri V, Lauria R, Pensabene M, De Laurentiis M, Augustin LSA, Amore A, D'Aiuto M, Tortoriello R, Accurso A, Cavalcanti E, Botti G, Montella M, De Placido S, Arpino G. Combined effect of obesity and diabetes on early breast cancer outcome: a prospective observational study. Oncotarget 2017; 8:115709-115717. [PMID: 29383194 PMCID: PMC5777806 DOI: 10.18632/oncotarget.22977] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 11/16/2017] [Indexed: 12/27/2022] Open
Abstract
Background Previous studies suggested that obesity and diabetes were correlated with breast cancer outcome. The aim of the present study was to investigate the prognostic effect of obesity and diabetes on the outcome of early breast cancer patients. Materials and Methods Overall, 841 early breast cancer patients were prospectively enrolled between January 2009 and December 2013. Study population was divided into four groups: (1) patients without obesity or diabetes; (2) patients with only diabetes; (3) patients with only obesity; and (4) patients with both diabetes and obesity. Categorical variables were analyzed by the chi-square test and survival data by the log-rank test. Results At diagnosis, obese and diabetic patients were more likely to be older (p < 0.0001) and post-menopausal (p < 0.0001) and to have a tumor larger than 2 cm (p < 0.0001) than patients in groups 1–3. At univariate analyses, obese and diabetic patients had a worse disease-free survival (p = 0.01) and overall survival (p = 0.001) than did patients without obesity and diabetes. At multivariate analyses, the co-presence of obesity and diabetes was an independent prognostic factor for disease-free survival (hazard ratio=2.62, 95% CI 1.23–5.60) but not for overall survival. Conclusions At diagnosis, patients with obesity and diabetes were older, had larger tumors and a worse outcome compared to patients without obesity or diabetes. These data suggest that metabolic health influences the prognosis of patients affected by early breast cancer.
Collapse
Affiliation(s)
- Giuseppe Buono
- Department of Clinical Medicine and Surgery, Oncology Division, University of Naples Federico II, Naples, Italy
| | - Anna Crispo
- Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - Mario Giuliano
- Department of Clinical Medicine and Surgery, Oncology Division, University of Naples Federico II, Naples, Italy.,Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX, USA
| | - Carmine De Angelis
- Department of Clinical Medicine and Surgery, Oncology Division, University of Naples Federico II, Naples, Italy
| | - Francesco Schettini
- Department of Clinical Medicine and Surgery, Oncology Division, University of Naples Federico II, Naples, Italy
| | - Valeria Forestieri
- Department of Clinical Medicine and Surgery, Oncology Division, University of Naples Federico II, Naples, Italy
| | - Rossella Lauria
- Department of Clinical Medicine and Surgery, Oncology Division, University of Naples Federico II, Naples, Italy
| | - Matilde Pensabene
- Department of Clinical Medicine and Surgery, Oncology Division, University of Naples Federico II, Naples, Italy
| | | | - Livia Silvia Adriana Augustin
- Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy.,Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada
| | - Alfonso Amore
- Breast Unit, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | | | | | - Antonello Accurso
- Department of Gastroenterology, Endocrinology and Surgery, University of Naples Federico II, Naples, Italy
| | - Ernesta Cavalcanti
- Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - Gerardo Botti
- Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - Maurizio Montella
- Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - Sabino De Placido
- Department of Clinical Medicine and Surgery, Oncology Division, University of Naples Federico II, Naples, Italy
| | - Grazia Arpino
- Department of Clinical Medicine and Surgery, Oncology Division, University of Naples Federico II, Naples, Italy
| |
Collapse
|
22
|
Crispo A, Augustin LSA, Grimaldi M, Nocerino F, Giudice A, Cavalcanti E, Di Bonito M, Botti G, De Laurentiis M, Rinaldo M, Esposito E, Riccardi G, Amore A, Libra M, Ciliberto G, Jenkins DJA, Montella M. Risk Differences Between Prediabetes And Diabetes According To Breast Cancer Molecular Subtypes. J Cell Physiol 2016; 232:1144-1150. [PMID: 27579809 DOI: 10.1002/jcp.25579] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 08/29/2016] [Indexed: 02/03/2023]
Abstract
Hyperglycemia and hyperinsulinemia may play a role in breast carcinogenesis and prediabetes and diabetes have been associated with increased breast cancer (BC) risk. However, whether BC molecular subtypes may modify these associations is less clear. We therefore investigated these associations in all cases and by BC molecular subtypes among women living in Southern Italy. Cases were 557 patients with non-metastatic incident BC and controls were 592 outpatients enrolled during the same period as cases and in the same hospital for skin-related non-malignant conditions. Adjusted multivariate logistic regression models were built to assess the risks of developing BC in the presence of prediabetes or diabetes. The analyses were repeated by strata of BC molecular subtypes: Luminal A, Luminal B, HER2+, and Triple Negative (TN). Prediabetes and diabetes were significantly associated with higher BC incidence after controlling for known risk factors (OR = 1.94, 95% CI 1.32-2.87 and OR = 2.46, 95% CI 1.38-4.37, respectively). Similar results were seen in Luminal A and B while in the TN subtype only prediabetes was associated with BC (OR = 2.43, 95% CI 1.11-5.32). Among HER2+ patients, only diabetes was significantly associated with BC risk (OR = 3.04, 95% CI 1.24-7.47). Furthermore, when postmenopausal HER2+ was split into hormone receptor positive versus negative, the association with diabetes remained significant only in the former (OR = 5.13, 95% CI 1.53-17.22). These results suggest that prediabetes and diabetes are strongly associated with BC incidence and that these metabolic conditions may be more relevant in the presence of breast cancer molecular subtypes with positive hormone receptors. J. Cell. Physiol. 232: 1144-1150, 2017. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- A Crispo
- Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - L S A Augustin
- Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy.,Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada
| | - M Grimaldi
- Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - F Nocerino
- Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - A Giudice
- Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - E Cavalcanti
- Department of Diagnostic Pathology and Laboratory, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - M Di Bonito
- Department of Diagnostic Pathology and Laboratory, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - G Botti
- Department of Diagnostic Pathology and Laboratory, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - M De Laurentiis
- Department of Breast Surgery, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - M Rinaldo
- Department of Breast Surgery, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - E Esposito
- Department of Breast Surgery, National Cancer Institute, G. Pascale Foundation, Naples, Italy.,Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - G Riccardi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - A Amore
- Department of Surgery, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - M Libra
- Section of Clinical and General Pathology and Oncology, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - G Ciliberto
- Scientific Direction, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - D J A Jenkins
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Canada
| | - M Montella
- Unit of Epidemiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| |
Collapse
|
23
|
Villarini M, Lanari C, Nucci D, Gianfredi V, Marzulli T, Berrino F, Borgo A, Bruno E, Gargano G, Moretti M, Villarini A. Community-based participatory research to improve life quality and clinical outcomes of patients with breast cancer (DianaWeb in Umbria pilot study). BMJ Open 2016; 6:e009707. [PMID: 27251681 PMCID: PMC4893863 DOI: 10.1136/bmjopen-2015-009707] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Breast cancer (BC) is the most frequent cancer in Europe and the International Agency for Research on Cancer (IARC) has estimated over 460 000 incident cases per year. Survival among patients with BC has increased in the past decades and EUROCARE-5 has estimated a 5-year relative survival rate of 82% for patients diagnosed in 2000-2007. There is growing evidence that lifestyle (such as a diet based on Mediterranean principles associated with moderate physical activity) may influence prognosis of BC; however, this information is not currently available to patients and is not considered in oncology protocols. Only a few epidemiological studies have investigated the role of diet in BC recurrence and metastasis. METHODS AND ANALYSIS DianaWeb is a community-based participatory research dedicated to patients with BC and represents a collaborative effort between participants and research institutions to determine if specified changes in lifestyle would result in improved outcomes in terms of quality of life or survival. The aim of the study is to recruit a large number of participants, to monitor their lifestyle and health status over time, to provide them tips to encourage sustainable lifestyle changes, to analyse clinical outcomes as a function of baseline risk factors and subsequent changes, and to share with patients methodologies and results. DianaWeb uses a specific interactive website (http://www.dianaweb.org/) and, with very few exceptions, all communications will be made through the web. In this paper we describe the pilot study, namely DianaWeb in Umbria. ETHICS AND DISSEMINATION DianaWeb does not interfere with prescribed oncological treatments; rather, it recommends that participants should follow the received prescriptions. The results will be used to plan guidelines for nutrition and physical activity for patients with BC. The pilot study was approved by the ethics committee of the University of Perugia (reference number 2015-002), and is supported by Fondazione Cassa di Risparmio di Perugia (2013.0185 021).
Collapse
Affiliation(s)
- Milena Villarini
- Department of Pharmaceutical Sciences, University of Perugia, Perugia, Italy
| | - Chiara Lanari
- Department of Pharmaceutical Sciences, University of Perugia, Perugia, Italy
| | - Daniele Nucci
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Vincenza Gianfredi
- School of Specialization in Hygiene and Preventive Medicine, University of Perugia, Perugia, Italy
| | - Tiziana Marzulli
- School of Specialization in Hygiene and Preventive Medicine, University of Perugia, Perugia, Italy
| | | | - Alessandra Borgo
- Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Eleonora Bruno
- Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Giuliana Gargano
- Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Massimo Moretti
- Department of Pharmaceutical Sciences, University of Perugia, Perugia, Italy
| | - Anna Villarini
- Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| |
Collapse
|
24
|
Boursi B, Giantonio BJ, Lewis JD, Haynes K, Mamtani R, Yang YX. Serum glucose and hemoglobin A1C levels at cancer diagnosis and disease outcome. Eur J Cancer 2016; 59:90-98. [PMID: 27017290 DOI: 10.1016/j.ejca.2016.02.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 02/11/2016] [Accepted: 02/16/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Despite the lack of scientific data, many cancer patients hold the belief that glucose 'feeds' cancer and might affect disease outcome. We aimed to evaluate associations between glucose, hemoglobin A1C (HbA1C), and survival among individuals with diabetes and diabetes associated cancers. METHODS Five retrospective cohort studies were conducted in a large population-representative database. The study population included all patients with diabetes and an incident diagnosis of colorectal, breast, bladder, pancreatic and prostate cancers. Exposure of interest was serum glucose or HbA1C levels within 6 months prior to cancer diagnosis. Cox regression model was used to calculate hazard-ratio (HR) and 95% confidence-interval (CI) for overall survival. Analyses were adjusted for cancer-specific confounders. A subgroup analysis was performed among insulin-treated patients. RESULTS Study cohorts included 7916 individuals with incident cancers and concurrent diabetes. There was no association between HbA1C levels and overall survival in colorectal (HR 1.00, 95% CI 0.95-1.06), breast (HR 1.03, 95% CI 0.95-1.11), bladder (HR 0.94, 95% CI 0.86-1.01), pancreatic (HR 0.98, 95% CI 0.94-1.02), or prostate (HR 1.02, 95% CI 0.96-1.08) cancers. Among diabetes patients treated with insulin, there was increased survival with increasing serum glucose, most prominent for bladder cancer (HR 0.91, 95% CI 0.84-0.99, per 1 mmol/l increase). CONCLUSIONS Higher glucose and HbA1C levels in diabetes patients with incident cancer are not associated with worse overall survival following cancer diagnosis. Among insulin-treated patients, higher glucose levels may be associated with improved survival.
Collapse
Affiliation(s)
- Ben Boursi
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA; Tel-Aviv University, Tel-Aviv, Israel.
| | - Bruce J Giantonio
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - James D Lewis
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Kevin Haynes
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ronac Mamtani
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Yu-Xiao Yang
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
25
|
Wulaningsih W, Vahdaninia M, Rowley M, Holmberg L, Garmo H, Malmstrom H, Lambe M, Hammar N, Walldius G, Jungner I, Coolen AC, Van Hemelrijck M. Prediagnostic serum glucose and lipids in relation to survival in breast cancer patients: a competing risk analysis. BMC Cancer 2015; 15:913. [PMID: 26577580 PMCID: PMC4650114 DOI: 10.1186/s12885-015-1928-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 11/12/2015] [Indexed: 11/10/2022] Open
Abstract
Background Abnormal glucose and lipids levels may impact survival after breast cancer (BC) diagnosis, but their association to other causes of mortality such as cardiovascular (CV) disease may result in a competing risk problem. Methods We assessed serum glucose, triglycerides (TG) and total cholesterol (TC) measured prospectively 3 months to 3 years before diagnosis in 1798 Swedish women diagnosed with any type of BC between 1985 and 1999. In addition to using Cox regression, we employed latent class proportional hazards models to capture any heterogeneity of associations between these markers and BC death. The latter method was extended to include the primary outcome (BC death) and competing outcomes (CV death and death from other causes), allowing latent class-specific hazard estimation for cause-specific deaths. Results A lack of association between prediagnostic glucose, TG or TC with BC death was observed with Cox regression. With latent class proportional hazards model, two latent classes (Class I and II) were suggested. Class I, comprising the majority (81.5 %) of BC patients, had an increased risk of BC death following higher TG levels (HR: 1.87, 95 % CI: 1.01–3.45 for every log TG increase). Lower overall survival was observed in Class II, but no association for BC death was found. On the other hand, TC positively corresponded to CV death in Class II, and similarly, glucose to death from other causes. Conclusion Addressing cohort heterogeneity in relation to BC survival is important in understanding the relationship between metabolic markers and cause-specific death in presence of competing outcomes. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1928-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Wahyu Wulaningsih
- Cancer Epidemiology Group, Division of Cancer Studies, King's College London, London, UK.
| | - Mariam Vahdaninia
- Cancer Epidemiology Group, Division of Cancer Studies, King's College London, London, UK.
| | - Mark Rowley
- Institute for Mathematical and Molecular Biomedicine, King's College London, London, UK.
| | - Lars Holmberg
- Cancer Epidemiology Group, Division of Cancer Studies, King's College London, London, UK. .,Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden. .,Regional Cancer Centre, Uppsala, Sweden.
| | - Hans Garmo
- Cancer Epidemiology Group, Division of Cancer Studies, King's College London, London, UK. .,Regional Cancer Centre, Uppsala, Sweden.
| | - Håkan Malmstrom
- Department of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Mats Lambe
- Regional Cancer Centre, Uppsala, Sweden. .,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Niklas Hammar
- Department of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. .,AstraZeneca Sverige, Södertalje, Sweden.
| | - Göran Walldius
- Department of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Ingmar Jungner
- Department of Medicine, Clinical Epidemiological Unit, Karolinska Institutet and CALAB Research, Stockholm, Sweden.
| | - Anthonius C Coolen
- Institute for Mathematical and Molecular Biomedicine, King's College London, London, UK.
| | - Mieke Van Hemelrijck
- Cancer Epidemiology Group, Division of Cancer Studies, King's College London, London, UK. .,Department of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| |
Collapse
|
26
|
Vici P, Sperati F, Maugeri-Saccà M, Melucci E, Di Benedetto A, Di Lauro L, Pizzuti L, Sergi D, Terrenato I, Esposito L, Iannuzzi CA, Pasquale R, Botti C, Fuhrman B, Giordano A, Mottolese M, Barba M. p53 status as effect modifier of the association between pre-treatment fasting glucose and breast cancer outcomes in non diabetic, HER2 positive patients treated with trastuzumab. Oncotarget 2015; 5:10382-92. [PMID: 25071015 PMCID: PMC4279380 DOI: 10.18632/oncotarget.2060] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 06/04/2014] [Indexed: 12/13/2022] Open
Abstract
Mounting evidence supports the role of p53 in metabolic processes involved in breast carcinogenesis. We investigated whether p53 status affects the association of pre-treatment fasting glucose with treatment outcomes in 106 non diabetic, HER2 positive breast cancer patients treated with trastuzumab. p53 status was validated against gene sequencing of selected codons in 49 patients. The Kaplan-Meier method and log rank test were used to compare survival by categories of fasting glucose in the overall population and separate settings. Cox models included age and body mass index. Direct sequencing confirmed the lack of mutations in 73.7% of p53 negative patients and their presence in 53.3% of p53 positive cases. At 66 months, 88.3% of patients with glucose ≤ 89.0 mg/dl (median value) did not experiment disease progression compared with 70.0% in the highest category (p=0.034), with glucose being an independent predictor (p=0.046). Stratified analysis confirmed this association in p53 negative patients only (p=0.01). In the early setting, data suggested longer disease free survival in p53 negative patients in the lowest glucose category (p=0.053). In our study, p53 status acted as effect modifier of the investigated association. This may help differentiate target sub-groups and affect outcomes interpretation in similarly characterized patients.
Collapse
Affiliation(s)
- Patrizia Vici
- Division of Medical Oncology B, Regina Elena National Cancer Institute, Rome, Italy
| | - Francesca Sperati
- Biostatistics-Scientific Direction, Regina Elena National Cancer Institute, Rome, Italy
| | - Marcello Maugeri-Saccà
- Division of Medical Oncology B-Scientific Direction, Regina Elena National Cancer Institute, Rome, Italy
| | - Elisa Melucci
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Anna Di Benedetto
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Luigi Di Lauro
- Division of Medical Oncology B, Regina Elena National Cancer Institute, Rome, Italy
| | - Laura Pizzuti
- Division of Medical Oncology B, Regina Elena National Cancer Institute, Rome, Italy
| | - Domenico Sergi
- Division of Medical Oncology B, Regina Elena National Cancer Institute, Rome, Italy
| | - Irene Terrenato
- Biostatistics-Scientific Direction, Regina Elena National Cancer Institute, Rome, Italy
| | - Luca Esposito
- Center for Oncologic Research of Mercogliano (CROM), Avellino, Italy
| | | | - Raffaella Pasquale
- Oncology Research Centre of Mercogliano (CROM), G. Pascale Foundation National Cancer Institute, Naples, Italy
| | - Claudio Botti
- Department of Surgery, Regina Elena National Cancer Institute, Rome, Italy
| | - Barbara Fuhrman
- Department of Epidemiology, University of Arkansas for Medical Sciences, Arkansas, USA
| | - Antonio Giordano
- Sbarro Institute for Cancer Research and Molecular Medicine and Center of Biotechnology, College of Science and Technology Temple University, Philadelphia, USA
| | - Marcella Mottolese
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Maddalena Barba
- Division of Medical Oncology B-Scientific Direction, Regina Elena National Cancer Institute, Rome, Italy
| |
Collapse
|
27
|
Marinac CR, Natarajan L, Sears DD, Gallo LC, Hartman SJ, Arredondo E, Patterson RE. Prolonged Nightly Fasting and Breast Cancer Risk: Findings from NHANES (2009-2010). Cancer Epidemiol Biomarkers Prev 2015; 24:783-9. [PMID: 25896523 PMCID: PMC4417458 DOI: 10.1158/1055-9965.epi-14-1292] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/13/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND A novel line of research has emerged, suggesting that daily feeding-fasting schedules that are synchronized with sleep-wake cycles have metabolic implications that are highly relevant to breast cancer. We examined associations of nighttime fasting duration with biomarkers of breast cancer risk among women in the 2009-2010 U.S. National Health and Nutrition Examination Survey. METHODS Dietary, anthropometric, and HbA1c data were available for 2,212 women, and 2-hour postprandial glucose concentrations were available for 1,066 women. Nighttime fasting duration was calculated using 24-hour food records. Separate linear regression models examined associations of nighttime fasting with HbA1c and 2-hour glucose concentrations. Logistic regression modeled associations of nighttime fasting with elevated HbA1c (HbA1c ≥ 39 mmol/mol or 5.7%) and elevated 2-hour glucose (glucose ≥ 140 mg/dL). All models adjusted for age, education, race/ethnicity, body mass index, total kcal intake, evening kcal intake, and the number of eating episodes per day. RESULTS Each 3-hour increase in nighttime fasting (roughly 1 SD) was associated with a 4% lower 2-hour glucose measurement [β, 0.96; 95% confidence interval (CI), 0.93-1.00; P < 0.05], and a nonstatistically significant decrease in HbA1c. Logistic regression models indicate that each 3-hour increase in nighttime fasting duration was associated with roughly a 20% reduced odds of elevated HbA1c (OR, 0.81; 95% CI, 0.68-0.97; P < 0.05) and nonsignificantly reduced odds of elevated 2-hour glucose. CONCLUSIONS A longer nighttime duration was significantly associated with improved glycemic regulation. IMPACT Randomized trials are needed to confirm whether prolonged nighttime fasting could improve biomarkers of glucose control, thereby reducing breast cancer risk.
Collapse
Affiliation(s)
- Catherine R Marinac
- Moores UCSD Cancer Center, University of California, San Diego, La Jolla, California. Graduate School of Public Health, San Diego State University, San Diego, California
| | - Loki Natarajan
- Moores UCSD Cancer Center, University of California, San Diego, La Jolla, California. Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, California
| | - Dorothy D Sears
- Moores UCSD Cancer Center, University of California, San Diego, La Jolla, California. Department of Medicine, Division of Endocrinology and Metabolism, University of California, San Diego, La Jolla, California
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, California
| | - Sheri J Hartman
- Moores UCSD Cancer Center, University of California, San Diego, La Jolla, California. Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, California
| | - Elva Arredondo
- Graduate School of Public Health, San Diego State University, San Diego, California
| | - Ruth E Patterson
- Moores UCSD Cancer Center, University of California, San Diego, La Jolla, California. Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, California.
| |
Collapse
|
28
|
Rilla K, Siiskonen H, Tammi M, Tammi R. Hyaluronan-coated extracellular vesicles--a novel link between hyaluronan and cancer. Adv Cancer Res 2015; 123:121-48. [PMID: 25081528 DOI: 10.1016/b978-0-12-800092-2.00005-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The synthesis of hyaluronan (HA) on the plasma membrane is a unique and still partly mysterious way of macromolecular biosynthesis. HA forms pericellular coats around many cell types and accumulates in the extracellular matrix (ECM) of growing and renewing tissues. It is secreted to high concentrations in body fluids with antifriction properties like pleural, peritoneal, and synovial fluids, but is also detectable in plasma, saliva, and urine. In pathological states, like cancer and inflammation, the amount of HA is increased around cells, in the ECM, and in the body fluids. HA is an indicator of poor prognosis for cancer patients and creates a favorable environment for cellular growth and motility. The recent finding that HA-coated extracellular vesicles act both as a product of HA synthase activity and as special vehicles for HA, and perhaps carry signals important for malignant growth, provides a novel link between HA and cancer. HA could be carried on the surface of these vesicles in tissues and body fluids, creating beneficial environments by itself, or by associated molecules, for the invasion and metastasis of cancer cells. The HA-coated plasma membrane protrusions and vesicles shed from them are potential biomarkers in cancer and other HA-associated disease states.
Collapse
Affiliation(s)
- Kirsi Rilla
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland.
| | - Hanna Siiskonen
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland; Department of Dermatology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Markku Tammi
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Raija Tammi
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| |
Collapse
|
29
|
Berrino F, Villarini A, Traina A, Bonanni B, Panico S, Mano MP, Mercandino A, Galasso R, Barbero M, Simeoni M, Bassi MC, Consolaro E, Johansson H, Zarcone M, Bruno E, Gargano G, Venturelli E, Pasanisi P. Metabolic syndrome and breast cancer prognosis. Breast Cancer Res Treat 2014; 147:159-65. [PMID: 25104441 DOI: 10.1007/s10549-014-3076-6] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 07/21/2014] [Indexed: 01/06/2023]
Abstract
Metabolic syndrome (MS), conventionally defined by the presence of at least three out of five dysmetabolic traits (abdominal obesity, hypertension, low plasma HDL-cholesterol, high plasma glucose and high triglycerides), has been associated with an increased risk of several age-related chronic diseases, including breast cancer (BC). This may have prognostic implications for BC survivors. 2,092 early stage BC survivors aged 35-70, recruited in eleven Italian centres 0-5 years after surgical treatment (1.74 years on average), were followed-up over 2.8 years on average for additional BC-related events, including BC-specific mortality, distant metastasis, local recurrences and contralateral BC. At recruitment, 20 % of the patients had MS. Logistic regression models were carried out to generate OR and 95 % confidence intervals (CI) for new BC events associated with MS, adjusting for baseline pathological prognostic factors. New BC events occurred in 164 patients, including 89 distant metastases. The adjusted ORs for women with MS versus women without any MS traits were 2.17 (CI 1.31-3.60) overall, and 2.45 (CI 1.24-4.82) for distant metastasis. The OR of new BC events for women with only one or two MS traits was 1.40 (CI 0.91-2.16). All MS traits were positively associated with new BC events, and significantly so for low HDL and high triglycerides. MS is an important prognostic factor in BC. As MS is reversible through lifestyle changes, interventions to decrease MS traits in BC patients should be implemented in BC clinics.
Collapse
Affiliation(s)
- Franco Berrino
- Epidemiology & Prevention Unit, Department of Preventive & Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, 20133, Milan, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Hyaluronan synthases (HAS1-3) in stromal and malignant cells correlate with breast cancer grade and predict patient survival. Breast Cancer Res Treat 2013; 143:277-86. [PMID: 24337597 DOI: 10.1007/s10549-013-2804-7] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 12/03/2013] [Indexed: 10/25/2022]
Abstract
Accumulation of hyaluronan (HA) in pericellular stroma and carcinoma cells is predictive of unfavorable patient prognosis in many epithelial cancers. However, it is not known whether the HA originates from carcinoma or stromal cells, or whether increased expression of hyaluronan synthase proteins (HAS1-3) contributes to HA accumulation. In this study, localization and expression of HAS1-3 were evaluated immunohistochemically in 278 cases of human breast cancer, and correlated with prognostic factors and patient outcome. Both carcinoma cells and stromal cells were HAS-positive. In carcinoma cells, HAS1 and HA stainings correlated with each other, and HAS1 associated with estrogen receptor negativity, HER2 positivity, high relapse rate, and short overall survival. In stromal cells, the staining levels of all HAS isoforms correlated with the stromal HA staining, stromal cell CD44, high relapse rate, and short overall survival of the patients. In addition, expression levels of stromal HAS1 and HAS2 were related to obesity, large tumor size, lymph node positivity, and estrogen receptor negativity. Thus, stromal HAS1 and HAS3 were independent prognostic factors in the multivariate analysis. The data suggest that increased levels of HAS enzymes contribute to the accumulation of HA in breast cancer, and that HA is synthesized in carcinoma cells and stromal cells. The study also indicates that HAS enzyme levels are related to tumor aggressiveness and poor patient outcome representing potential targets for therapy.
Collapse
|
31
|
Minicozzi P, Berrino F, Sebastiani F, Falcini F, Vattiato R, Cioccoloni F, Calagreti G, Fusco M, Vitale MF, Tumino R, Sigona A, Budroni M, Cesaraccio R, Candela G, Scuderi T, Zarcone M, Campisi I, Sant M. High fasting blood glucose and obesity significantly and independently increase risk of breast cancer death in hormone receptor-positive disease. Eur J Cancer 2013; 49:3881-8. [PMID: 24011933 DOI: 10.1016/j.ejca.2013.08.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 07/06/2013] [Accepted: 08/08/2013] [Indexed: 12/19/2022]
Abstract
PURPOSE We investigated the effect of fasting blood glucose and body mass index (BMI) at diagnosis on risk of breast cancer death for cases diagnosed in five Italian cancer registries in 2003-2005 and followed up to the end of 2008. METHODS For 1607 Italian women (≥15 years) with information on BMI or blood glucose or diabetes, we analysed the risk of breast cancer death in relation to glucose tertiles (≤84.0, 84.1-94.0, >94.0 mg/dl) plus diabetic and unspecified categories; BMI tertiles (≤23.4, 23.5-27.3, >27.3 kg/m(2), unspecified), stage (T1-3N0M0, T1-3N+M0 plus T4anyNM0, M1, unspecified), oestrogen (ER) and progesterone (PR) status (ER+PR+, ER-PR-, ER and PR unspecified, other), age, chemotherapy and endocrine therapy, using multiple regression models. Separate models for ER+PR+ and ER-PR- cases were also run. RESULTS Patients often had T1-3N0M0, ER+PR+ cancers and received chemotherapy or endocrine therapy; only 6% were M1 and 17% ER-PR-. Diabetic patients were older and had more often high BMI (>27 kg/m(2)), ER-PR-, M1 cancers than other patients. For ER+PR+ cases, with adjustment for other variables, breast cancer mortality was higher in women with high BMI than those with BMI 23.5-27.3 kg/m(2) (hazard ratio (HR)=2.9, 95% confidence interval (CI) 1.2-6.9). Breast cancer mortality was also higher in women with high (>94 mg/dl) blood glucose compared to those with glucose 84.1-94.0mg/dl (HR=2.6, 95% CI 1.2-5.7). CONCLUSION Our results provide evidence that in ER+PR+ patients, high blood glucose and high BMI are independently associated with increased risk of breast cancer death. Detection and correction of these factors in such patients may improve prognosis.
Collapse
Affiliation(s)
- Pamela Minicozzi
- Analytical Epidemiology and Health Impact Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|