Jang Eun Kyung, Kim Won Gu, Kwon Hyemi, Choi Yun Mi, Jeon Min Ji, Kim Tae Yong, Shong Young Kee, Kim Won Bae, Kim Eui Young
Department of Endocrinology, Dongnam Institute of Radiological and Medical Sciences Cancer Center, Busan, Korea ; Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Eur Thyroid J. 2015 Sep;4(3):181-8. doi: 10.1159/000437365. Epub 2015 Aug 20.
Type 2 diabetes is known to increase the risk and progression of certain types of cancer. Metformin treatment of diabetic patients is reported to have beneficial effects on some cancers. We evaluated the clinical outcome of diabetic patients with differentiated thyroid cancer (DTC) according to metformin treatment.
We reviewed 943 patients diagnosed with DTC after total thyroidectomy between 1995 and 2005 in a tertiary hospital. The study involved 60 diabetic patients and 210 control patients matched for age, sex, body mass index (BMI), and tumor size.
There were no differences in the clinicopathological features and disease-free survival (DFS) between diabetic patients and the control group over 8.9 years of follow-up. Of the diabetic patients with DTC, 35 patients (58%) were treated with metformin. There were no differences in age, sex, BMI, tumor size, antidiabetic medication, glycated hemoglobin, or C-peptide levels in metformin and nonmetformin groups. However, cervical lymph node (LN) metastasis was more prevalent in the metformin group than in the nonmetformin group (OR 3.52, p = 0.035). Among diabetic patients with cervical LN metastasis of DTC, the metformin subgroup (17.1 years) was associated with longer DFS than the nonmetformin subgroup (8.6 years) (HR 0.16, p = 0.021); metformin treatment was also associated with longer DFS in this subgroup in multivariate analysis after adjusting age, BMI, duration of diabetes, presence of tumor at resection margin, and serum thyroglobulin level at ablation (HR 0.03, p = 0.035).
Metformin treatment is associated with low recurrence in diabetic patients with cervical LN metastasis of DTC.
已知2型糖尿病会增加某些类型癌症的风险及进展。据报道，二甲双胍治疗糖尿病患者对某些癌症有有益作用。我们根据二甲双胍治疗情况评估了分化型甲状腺癌（DTC）糖尿病患者的临床结局。
我们回顾了1995年至2005年在一家三级医院接受全甲状腺切除术后被诊断为DTC的943例患者。该研究纳入了60例糖尿病患者和210例年龄、性别、体重指数（BMI）及肿瘤大小相匹配的对照患者。
在8.9年的随访中，糖尿病患者与对照组之间的临床病理特征及无病生存期（DFS）无差异。在患有DTC的糖尿病患者中，35例（58%）接受了二甲双胍治疗。二甲双胍组和非二甲双胍组在年龄、性别、BMI、肿瘤大小、抗糖尿病药物、糖化血红蛋白或C肽水平方面无差异。然而，二甲双胍组颈部淋巴结（LN）转移比非二甲双胍组更常见（OR 3.52，p = 0.035）。在患有DTC颈部LN转移的糖尿病患者中，二甲双胍亚组（17.1年）的DFS比非二甲双胍亚组（8.6年）更长（HR 0.16，p = 0.021）；在调整年龄、BMI、糖尿病病程、切除边缘肿瘤的存在情况及消融时血清甲状腺球蛋白水平后，多因素分析显示二甲双胍治疗在该亚组中也与更长的DFS相关（HR 0.03，p = 0.035）。
二甲双胍治疗与患有DTC颈部LN转移的糖尿病患者的低复发率相关。
