dc.contributor.author | Lende, Tone Hoel | en_US |
dc.contributor.author | Austdal, Marie | en_US |
dc.contributor.author | Varhaugvik, Anne Elin | en_US |
dc.contributor.author | Skaland, Ivar | en_US |
dc.contributor.author | Gudlaugsson, Einar | en_US |
dc.contributor.author | Kvaløy, Jan Terje | en_US |
dc.contributor.author | Akslen, Lars A. | en_US |
dc.contributor.author | Søiland, Håvard | en_US |
dc.contributor.author | Janssen, Emiel | en_US |
dc.contributor.author | Baak, Jan P.A. | en_US |
dc.date.accessioned | 2020-03-12T10:13:58Z | |
dc.date.available | 2020-03-12T10:13:58Z | |
dc.date.issued | 2019-11-08 | |
dc.Published | Lende TH, Austdal M, Varhaugvik AE, Skaland I, Gudlaugsson E, Kvaløy JT, Akslen LA, Søiland H, Janssen EAM, Baak JPA. Influence of pre-operative oral carbohydrate loading vs. standard fasting on tumor proliferation and clinical outcome in breast cancer patients - a randomized trial. BMC Cancer. 2019;19:1076 | eng |
dc.identifier.issn | 1471-2407 | |
dc.identifier.uri | https://hdl.handle.net/1956/21472 | |
dc.description.abstract | Background: Conflicting results have been reported on the influence of carbohydrates in breast cancer. Objective: To determine the influence of pre-operative per-oral carbohydrate load on proliferation in breast tumors. Design: Randomized controlled trial. Setting: University hospital with primary and secondary care functions in South-West Norway. Patients: Sixty-one patients with operable breast cancer from a population-based cohort. Intervention: Per-oral carbohydrate load (preOp™) 18 and 2–4 h before surgery (n = 26) or standard pre-operative fasting with free consumption of tap water (n = 35). Measurements: The primary outcome was post-operative tumor proliferation measured by the mitotic activity index (MAI). The secondary outcomes were changes in the levels of serum insulin, insulin-c-peptide, glucose, IGF-1, and IGFBP3; patients’ well-being, and clinical outcome over a median follow-up of 88 months (range 33–97 months). Results: In the estrogen receptor (ER) positive subgroup (n = 50), high proliferation (MAI ≥ 10) occurred more often in the carbohydrate group (CH) than in the fasting group (p = 0.038). The CH group was more frequently progesterone receptor (PR) negative (p = 0.014). The CH group had a significant increase in insulin (+ 24.31 mIE/L, 95% CI 15.34 mIE/L to 33.27 mIE/L) and insulin c-peptide (+ 1.39 nM, 95% CI 1.03 nM to 1.77 nM), but reduced IGFBP3 levels (− 0.26 nM; 95% CI − 0.46 nM to − 0.051 nM) compared to the fasting group. CH-intervention ER-positive patients had poorer relapse-free survival (73%) than the fasting group (100%; p = 0.012; HR = 9.3, 95% CI, 1.1 to 77.7). In the ER-positive patients, only tumor size (p = 0.021; HR = 6.07, 95% CI 1.31 to 28.03) and the CH/fasting subgrouping (p = 0.040; HR = 9.30, 95% CI 1.11 to 77.82) had independent prognostic value. The adverse clinical outcome of carbohydrate loading occurred only in T2 patients with relapse-free survival of 100% in the fasting group vs. 33% in the CH group (p = 0.015; HR = inf). The CH group reported less pain on days 5 and 6 than the control group (p < 0.001) but otherwise exhibited no factors related to well-being. Limitation: Only applicable to T2 tumors in patients with ER-positive breast cancer. Conclusions: Pre-operative carbohydrate load increases proliferation and PR-negativity in ER-positive patients and worsens clinical outcome in ER-positive T2 patients. | en_US |
dc.language.iso | eng | eng |
dc.publisher | BMC | eng |
dc.rights | Attribution CC BY | eng |
dc.rights.uri | http://creativecommons.org/licenses/by/4.0 | eng |
dc.subject | Breast cancer | eng |
dc.subject | Carbohydrate load | eng |
dc.subject | Proliferation | eng |
dc.subject | Insulin | eng |
dc.subject | Insulin c-peptide | eng |
dc.subject | IGF-1 | eng |
dc.subject | IGFBP3 | eng |
dc.subject | Tumor size | eng |
dc.subject | Relapse-free survival | eng |
dc.subject | Breast cancer-specific survival | eng |
dc.title | Influence of pre-operative oral carbohydrate loading vs. standard fasting on tumor proliferation and clinical outcome in breast cancer patients - a randomized trial | en_US |
dc.type | Peer reviewed | |
dc.type | Journal article | |
dc.date.updated | 2020-02-10T18:32:35Z | |
dc.description.version | publishedVersion | en_US |
dc.rights.holder | Copyright 2019 The Authors | |
dc.identifier.doi | https://doi.org/10.1186/s12885-019-6275-z | |
dc.identifier.cristin | 1760810 | |
dc.source.journal | BMC Cancer | |