Liu Feifei, Yan Lijing, Wang Zhan, Lu Yuanan, Chu Yuanyuan, Li Xiangyu, Liu Yisi, Rui Dongsheng, Nie Shaofa, Xiang Hao
Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, 430071, China.
Global Health Institute, Wuhan University, Wuhan, 430071, China.
Oncotarget. 2017 Feb 28;8(9):16017-16026. doi: 10.18632/oncotarget.13762.
Recent evidence indicates that metformin therapy may be associated with a decreased colorectal adenoma/colorectal cancer risk in type 2 diabetes patients. However, results are not consistent. We therefore performed a systematic review and meta-analysis to assess the association between metformin therapy and risk of colorectal adenomas/colorectal cancer in type 2 diabetes mellitus patients. We searched the literature published before Aug 31, 2016 in four databases: PubMed, Embase database, CNKI and VIP Library of Chinese Journal. Summary risk estimates (adjusted OR/adjusted RR/adjusted HR) with their 95% confidence interval (95% CI) were obtained using a random effects model. Twenty studies (including 12 cohort studies, 7 case-control studies and 1 randomized controlled trial study) were selected in terms of data of colorectal adenomas or colorectal cancer incidence. Metformin therapy was found to be associated with a decreased incidence of colorectal adenomas (unadjusted OR=0.80, 95% CI: 0.71-0.90, p=0.0002). When the adjusted data were analyzed, the summary estimate decreased to 25% reduction in colorectal adenomas risk (adjusted OR=0.75, 95% CI: 0.59-0.97, p=0.03). Besides, a significant reduction of colorectal cancer risk was also observed (unadjusted OR=0.73, 95% CI: 0.62-0.86, p=0.0002). And when the adjusted data were analyzed, colorectal cancer risk for metformin users was decreased with a reduction of 22%, compared with non-metformin users and other treatment users (adjusted OR=0.78, 95% CI: 0.70-0.87, p<0.00001). Our meta-analysis suggested that metformin therapy may be associated with a decreased risk of colorectal adenomas and colorectal cancer in type 2 diabetes mellitus patients.
近期证据表明，二甲双胍治疗可能与2型糖尿病患者结直肠腺瘤/结直肠癌风险降低相关。然而，结果并不一致。因此，我们进行了一项系统评价和荟萃分析，以评估二甲双胍治疗与2型糖尿病患者结直肠腺瘤/结直肠癌风险之间的关联。我们检索了2016年8月31日前在四个数据库发表的文献：PubMed、Embase数据库、中国知网和维普中文期刊数据库。采用随机效应模型获得汇总风险估计值（调整后的OR/调整后的RR/调整后的HR）及其95%置信区间（95%CI）。根据结直肠腺瘤或结直肠癌发病率数据，选取了20项研究（包括12项队列研究、7项病例对照研究和1项随机对照试验研究）。结果发现，二甲双胍治疗与结直肠腺瘤发病率降低相关（未调整的OR=0.80，95%CI：0.71-0.90，p=0.0002）。分析调整后的数据时，汇总估计值显示结直肠腺瘤风险降低了25%（调整后的OR=0.75，95%CI：0.59-0.97，p=0.03）。此外，还观察到结直肠癌风险显著降低（未调整的OR=0.73，95%CI：0.62-0.86，p=0.0002）。分析调整后的数据时，与未使用二甲双胍的患者及其他治疗的患者相比，使用二甲双胍的患者结直肠癌风险降低了22%（调整后的OR=0.78，95%CI：0.70-0.87，p<0.00001）。我们的荟萃分析表明，二甲双胍治疗可能与2型糖尿病患者结直肠腺瘤和结直肠癌风险降低相关。
