Investigating the Association Between Type 2 Diabetes Mellitus and Pathological Responses Among Breast Cancer Patients Receiving Neoadjuvant Chemotherapy

Saba Javed; Dzul Azri Mohamed Noor; Nur Hafzan Md Hanafiah; Umar Javed; Tanveer Mustafa; Anees Ur Rehman; Sabariah Noor Harun

doi:10.1016/j.jss.2024.04.001

Investigating the Association Between Type 2 Diabetes Mellitus and Pathological Responses Among Breast Cancer Patients Receiving Neoadjuvant Chemotherapy

J Surg Res. 2024 May 7:299:85-93. doi: 10.1016/j.jss.2024.04.001. Online ahead of print.

Authors

Saba Javed¹, Dzul Azri Mohamed Noor², Nur Hafzan Md Hanafiah², Umar Javed³, Tanveer Mustafa³, Anees Ur Rehman⁴, Sabariah Noor Harun⁵

Affiliations

¹ School of Pharmaceutical Sciences, Universiti Sains Malaysia, USM Penang, Malaysia; Faculty of Pharmaceutical Sciences, Department of Pharmacy Practice, Government College University, Faisalabad, Pakistan.
² School of Pharmaceutical Sciences, Universiti Sains Malaysia, USM Penang, Malaysia.
³ Gujranwala Institute of Nuclear Medicine & Radiotherapy (GINUM), Gujranwala, Pakistan.
⁴ Faculty of Pharmacy, Department of Pharmacy Practice, Bahauddin Zakariya University Multan, Punjab, Pakistan.
⁵ School of Pharmaceutical Sciences, Universiti Sains Malaysia, USM Penang, Malaysia. Electronic address: sabariahnoor@usm.my.

PMID: 38718688
DOI: 10.1016/j.jss.2024.04.001

Abstract

Introduction: The relationship between type 2 diabetes mellitus (T2DM) and pathological responses after neoadjuvant chemotherapy (NACT) is controversial. In this study, we aim to determine the association of pathological responses in breast cancer women with T2DM after receiving NACT.

Methods: Medical records of breast cancer women with T2DM who received NACT from January 2016 to January 2021 at the medical center in the Gujranwala Institute of Nuclear Medicine and Radiotherapy, Pakistan, were identified and retrieved retrospectively. Variables, including pathological responses, diabetes status, and other clinical data, were collected. Patients were grouped as diabetic and nondiabetic based on the doctor's diagnosis or the diabetic's medication history recorded upon the breast cancer diagnosis. Factors influencing the pathological complete response (pCR) were determined using multivariate logistic regression utilizing IBM SPSS Statistics (version 20).

Results: A total of 1372 patient files who received NACT and breast cancer surgery from January 2016 to January 2021 were selected. Out of 1372 breast cancer women receiving NACT, 345 (25.1%) had pre-existing diabetes, while 1027 (74.85%) were without pre-existing diabetes. The most common molecular subtypes of breast cancer were luminal A and B. Two hundred fifty-eight patients (18.8%) had a pCR after receiving NACT. The pCR in diabetic patients was 3.9%, and in nondiabetes, 14.9%. Most women had a pathological partial response (pPR) after the NACT 672 (48.9%). The pPR in diabetic patients was 11.0%, and in nondiabetic patients, it was 38.0%. In nondiabetics, the odds of achieving pPR increase more than pathological no response after the NACT with odd ratio: 1.71 (95% confidence interval: 1.24-2.37). The probability of pCR in patients with luminal B was 1.67 times higher than that in patients with triple-negative breast cancer with odd ratio: 1.67, 95% confidence interval (1.00-2.79), P = 0.05.

Conclusions: The results of the study show that T2DM may have an adverse impact on pCR and pPR following NACT and surgery. Further investigation is needed to explore how changes in blood glucose levels over time impact pathological responses.

Keywords: Breast cancer; Clinical Pharmacy; Neoadjuvant chemotherapy; Pathological responses; diabetes status.