Beck Emmanuel, Scheen André J
Unité de pharmacologie clinique, service de diabétologie, nutrition et maladies métaboliques, département de médecine, université de Liège, CHU Sart Tilman (B35), 4000 Liège 1, Belgique.
Ann Endocrinol (Paris). 2013 May;74(2):137-47. doi: 10.1016/j.ando.2013.02.009. Epub 2013 Apr 6.
With the better management of cardiovascular risk factors, cancer plays an increasing role in the causes of death among patients with type 2 diabetes. Numerous epidemiological cohort and case-control studies showed that type 2 diabetes is a risk factor for cancer and that metformin therapy is associated with a significant reduction in the incidence of cancer and cancer-related death when compared to other glucose-lowering agents (sulfonylureas, insulin). Such beneficial effect is observed almost whatever the type of cancer, but seems to be more prominent in case of gastrointestinal and breast cancers. Several studies showed a significant relationship between the amplitude of the protection against cancer, on the one hand, and the daily dose of metformin and the duration of exposure, on the other hand. In general, the protective effect was more evident in observational cohort studies (however, more exposed to bias due to confounding factors) than in case-control studies. Several meta-analyses recently confirmed that metformin therapy reduces the incidence of cancers and cancer-related mortality. However, the results of the rather rare controlled clinical trials available are not conclusive, but none of them was performed with the objective to specifically assess cancer risk. Considering all promising clinical information in patients with type 2 diabetes, further clinical trials are currently ongoing with the aim of assessing the role of metformin in oncology, independently of the presence of diabetes.
随着心血管危险因素得到更好的控制，癌症在2型糖尿病患者死因中所占的比重日益增加。大量的流行病学队列研究和病例对照研究表明，2型糖尿病是癌症的一个危险因素，并且与其他降糖药物（磺脲类、胰岛素）相比，二甲双胍治疗可使癌症发病率和癌症相关死亡率显著降低。几乎无论何种癌症类型均可观察到这种有益作用，但在胃肠道癌和乳腺癌中似乎更为显著。多项研究表明，一方面，二甲双胍对癌症的保护程度，与另一方面的二甲双胍日剂量和暴露时长之间存在显著关联。总体而言，观察性队列研究中的保护作用（然而，因混杂因素而更容易受到偏倚影响）比病例对照研究中更为明显。最近的几项荟萃分析证实，二甲双胍治疗可降低癌症发病率和癌症相关死亡率。然而，现有的为数不多的对照临床试验结果并不具有决定性意义，而且这些试验均不是以专门评估癌症风险为目的开展的。鉴于2型糖尿病患者中有诸多前景可观的临床信息，目前正在进行进一步的临床试验，旨在评估二甲双胍在肿瘤学中的作用，而不考虑糖尿病的存在情况。
