Ki Young-Jun, Kim Hyo Jeong, Kim Mi-Sook, Park Chan Mi, Ko Min Jung, Seo Young Seok, Moon Sun Mi, Choi Jin A
Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea.
National Evidence-based Healthcare Collaborating Agency, Seoul, Korea.
Cancer Res Treat. 2017 Jan;49(1):29-36. doi: 10.4143/crt.2016.128. Epub 2016 Jul 4.
Metformin is associated with an anticancer effect. However, the effects of metformin in rectal cancer are controversial. This study investigated the impact of metformin on the survival of patients with diabetes mellitus and nonmetastatic rectal cancer who underwent curative surgery.
The database was provided by the Korea Center Cancer Registry and National Health Insurance Service of the Republic of Korea. A cohort of patients with newly diagnosed rectal cancer between 2005 and 2011 was identified. Drug exposure was defined as receiving the oral hypoglycemic agent for at least 90 days over the period from 6 months before the initial diagnosis of rectal cancer to the last follow-up.
A total of 4,503 patients were prescribed oral hypoglycemic agents and classified as the diabetic group, of which 3,694 patients received metformin for at least 90 days. Unadjusted analyses showed a significantly higher overall survival (hazard ratio, 0.596; 95% confidence interval, 0.506 to 0.702) and rectal cancer-specific survival (hazard ratio, 0.621; 95% confidence interval, 0.507 to 0.760) in the metformin group than in the nonmetformin group. The adjusted overall survival (hazard ratio, 0.631; 95% confidence interval, 0.527 to 0.755) and cancer-specific survival (hazard ratio, 0.598; 95% confidence interval, 0.479 to 0.746) in the group with a medication possession ratio of 80% or greater was significantly higher than in the group with a medication possession ratio of less than 80%.
Metformin use is associated with overall and cancer-specific survival in diabetic patients with a nonmetastatic rectal cancer treated with a curative resection.
二甲双胍具有抗癌作用。然而，二甲双胍对直肠癌的影响存在争议。本研究调查了二甲双胍对接受根治性手术的糖尿病合并非转移性直肠癌患者生存情况的影响。
数据库由韩国癌症中心登记处和大韩民国国民健康保险服务提供。确定了一组2005年至2011年间新诊断为直肠癌的患者。药物暴露定义为从直肠癌初诊前6个月至最后一次随访期间接受口服降糖药至少90天。
共有4503例患者被处方口服降糖药并被归类为糖尿病组，其中3694例患者接受二甲双胍至少90天。未调整分析显示，二甲双胍组的总生存期（风险比，0.596；95%置信区间，0.506至0.702）和直肠癌特异性生存期（风险比，0.621；95%置信区间，0.507至0.760）显著高于非二甲双胍组。药物持有率为80%或更高组的调整后总生存期（风险比，0.631；95%置信区间，0.527至0.755）和癌症特异性生存期（风险比，0.598；95%置信区间，0.479至0.746）显著高于药物持有率低于80%的组。
在接受根治性切除治疗的非转移性直肠癌糖尿病患者中，使用二甲双胍与总生存期和癌症特异性生存期相关。
