Diabetes Mellitus and Survival Outcomes in Women With Early-Stage Triple-Negative Breast Cancer: A Multicentre Population-Based Cohort Study From Saskatchewan.
Rabia K Shahid, Michelle Brabant, Prosanta Mondal, Osama Ahmed, Mita Manna, Shahid Ahmed
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Abstract
Objective: Diabetes mellitus has been associated with worse outcomes in several malignancies, yet its impact on women with early-stage triple-negative breast cancer (TNBC) remains unclear. This multicentre population-based cohort study evaluated the association between diabetes and survival outcomes in women with TNBC treated with neoadjuvant and/or adjuvant (curative-intent) chemotherapy.
Methods: Adult women diagnosed with stages I to III TNBC in Saskatchewan, Canada (2010 to 2018), were identified. Patients were categorized by diabetes status. Overall survival (OS), disease-free survival (DFS), and invasive DFS were assessed using Kaplan-Meier methods, with multivariable Cox regression and inverse probability of treatment weighting (IPTW) to control for confounding factors.
Results: Among 357 eligible women, 36 (10%) had diabetes. With a median follow-up of 88 months, women with diabetes experienced significantly inferior 5-year OS (61% vs 83%) and DFS (56% vs 78%) compared with women without diabetes (p<0.001). Diabetes was independently associated with worse DFS (hazard ratio: 2.95, 95% confidence interval: 1.73 to 5.04) and OS (hazard ratio: 2.73, 95% confidence interval: 1.55 to 4.79). Inverse probability of treatment weighting analysis confirmed the adverse impact of diabetes on survival.
Conclusions: Diabetes is independently associated with significantly inferior DFS and OS in women receiving curative-intent chemotherapy for early-stage TNBC. Improved diabetes management during cancer care may represent an opportunity to enhance outcomes. Further prospective studies are warranted.
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