Meme kanserinde neoadjuvan kemoterapi yanıtlarını öngörmede belirleyici olarak açlık kan şekeri ve vücut kitle indeksi

Year 2023, Volume: 28 Issue: 1, 66 - 71, 20.01.2023

Özgecan Dülgar , Seval Ay , Mahmut Gümüş

https://doi.org/10.21673/anadoluklin.1135546

Abstract

Amaç: Obezite, meme kanseri gelişiminde etkili olabilen değiştirilebilir bir risk faktörüdür. Bozulmuş açlık glikozu ise metabolik sendromun bir bileşenidir ve diyabet gelişimi için önemli bir risk faktörüdür. Metabolik sendromun bu iki ana bileşeninin meme kanserinde neoadjuvan kemoterapi (NAK) yanıtı üzerindeki etkisini araştırmayı amaçladık.

Yöntemler: Ocak 2016’dan Ocak 2022’ye kadar NAK alan 161 meme kanseri hastasını geriye dönük olarak inceledik. Açlık plazma glukoz (APG) seviyeleri en az iki kez ölçüldü ve NAK’a başlamadan önceki vücut kitle indeksileri (VKİ) kaydedildi. Bozulmuş açlık glukozu, 100 ile 125 mg/dl plazma glukoz seviyeleri olarak tanımlandı. Analizler, APG seviyelerine göre 100 mg/dl’nin altındaki ve üzerindeki veya VKİ'ye göre obez (VKİ 30≥ kg/m2) ve obez olmayan (VKİ <30 kg/m2) olacak şekilde karşılaştırılarak yapıldı. NAK yanıtları Miller-Payne derecelendirme sistemine göre, grade 1 yanıtsız, grade 2 %30’dan az, grade 3 %30 ile %90 arası, grade 4 %90’dan fazla yanıt ve grade 5 patolojik tam yanıt (pTY) olacak şekilde sınıflandırıldı.

Bulgular: Bozulmuş açlık glukoz düzeyleri olan hastaların NAK sonrası patolojik yanıtlarının %70.8’i, grade 1 yanıtsız grubundaydı. Bozulmuş açlık glukozu olan hastalarda, hastalıksız sağ-kalım, normal APG’si olan hastalara göre daha kısaydı (p=0.031). Tek değişkenli analizde, klinik evrenin 3 olması (p<0,001), postmenopozal durum (p=0,037), HER-2 negatifliği (p<0,001), östrojen reseptör (ER) pozitifliği (p<0,001), progesteron reseptör (PR) pozitifliği (p<0,001) patolojik yanıtlara göre grade 1 yanıt vermeyen grupta, grade 2, grade 3 ve grade 4 olan hastalara kıyasla daha yüksekti. Çok değişkenli analizde APG, klinik evre, HER-2 (human epidermal growth factor receptor 2) durumu ve ER durumu, patolojik tam yanıt için bağımsız öngörücü faktörler olarak bulundu. VKİ’nin pTY üzerinde etkisi gösterilemedi. Çalışmamız, bozulmuş açlık glukozu olan hastalarda pTY oranının, normal APG seviyelerine sahip hastalardakinden 2,5 kat daha düşük olduğunu gösterdi [HR: 2,5, %95 CI 1.08–5.92, p=0,03].

Sonuç: Açlık plazma glukozunun hem pTY hem de nüks üzerinde istatistiksel anlamlı bir etkisi bulunmaktadır.

Keywords

Kan şekeri, meme kanseri, neoadjuvan tedavi

Fasting plasma glucose and body mass index as predictors of neoadjuvant chemotherapy response in breast cancer

Abstract

Aim: Obesity is a well-known modifiable risk factor for breast cancer. Impaired fasting glucose is a component of metabolic syndrome and a significant risk for diabetes. We aimed to research the effect of these two major components of metabolic syndrome on neoadjuvant chemotherapy (NAC) response in breast cancer.

Methods: We conducted 161 patients who had received NAC from January 2016 to January 2022. Fasting plasma glucose levels were measured at least two times and BMI was recorded before starting NAC. Impaired fasting glucose is defined as plasma glucose levels of 100 to 125 mg per dL. Analyses were compared into two groups according to FPG levels below or above 100 mg/dl and according to BMI obese (BMI30≥ kg/m2), or non-obese (BMI <30 kg/m2). The pathologic response was evaluated, and patients were divided into five groups according to the Miller-Payne grading system classified from grade V to I, complete pathologic response, loss of more than 90% of tumor cells, reduced 30% and 90% of tumor cells, lost less than 30% of tumor cells, and had no reduction in cellularity and no change malignant cells respectively

Results: In the pathologic responses, 70.8% of patients with impaired fasting glucose levels were grade 1 non-reduction with NAC. Disease free-survival was shorter in the group that had impaired fasting glucose than in the group that had normal fasting plasma glucose (FPG) (p=0.031). In univariate analysis clinical stage 3 (p <0.001), postmenopausal status (p=0.037), human epidermal growth factor receptor 2 (HER-2) negativity (p<0.001), estrogen receptor (ER) positivity (p <0.001), progesterone receptor (PR) positivity (p <0.001) rate were higher in grade 1 unresponsive patients compared to patients with pathological response grade 2, grade 3 and grade 4. In multivariate analysis showed that fasting plasma glucose, clinical stage, HER-2 status, and ER status were independent predictor factors for pathological complete response (pCR). BMI had no impact on pCR. Our trial showed that the ratio of pCR in patients with impaired fasting glucose was 2.5 times lower than that in patients who had normal FPG levels [HR: 2.5, 95%CI 1.08–5.92, p = 0.03].

Conclusion: Fasting plasma glucose significantly impacted both pCR and recurrence. 

Keywords

Blood glucose, breast cancer, neoadjuvant therapy

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