University of Helsinki, Clinicum, Helsinki, Finland.
Endocrinology and Diabetology, Abdominal Center, Helsinki University Hospital and Universities of Helsinki and Eastern Finland, Helsinki, Finland.
Int J Cancer. 2017 Dec 15;141(12):2437-2449. doi: 10.1002/ijc.31016. Epub 2017 Sep 4.
Both diabetes mellitus (DM) and cancer are common diseases and they frequently occur in the same patients. We investigated the all-cause and cause-specific mortality dynamics in relation to baseline DM, statin use and metformin use. The study population consisted of 39,900 incident cancer cases from Finland, 19,822 patients were free of DM at the start of follow-up and 20,078 had DM. Mortality from all causes, and cancer, cardiovascular (CVD) and other causes was analysed using Poisson regression model with the following variables: sex, age, DM, statin and metformin usage in baseline, cancer type and stage and calendar period. Statin usage was associated with a reduced cancer-specific mortality with incidence rate ratio (IRR) 0.72 (95% confidence interval 0.69-0.74), IRR for CVD mortality was 0.95 (0.88-1.02) and for other causes 0.64 (0.56-0.74). In a sub-population of DM patients, IRR for metformin in all-cause mortality was 0.74 (0.71-0.78), in cancer mortality 0.75 (0.72-0.79), in CVD mortality 0.75 (0.68-0.83) and other causes 0.68 (0.60-0.78). In conclusion, our register-based study of survival after cancer diagnosis showed that patients with diabetes had substantially poorer outcome in all measures. An association between baseline statin usage and lower all-cause, cancer and cardiovascular mortality was modified by cancer type. The effect of statin use was largest for breast and colorectal cancer. Metformin usage in a subpopulation of oral antidiabetic users was in general associated with lower mortality, but this association was modified by cancer type. The association was strongest for liver, colorectal and breast cancer.
糖尿病（DM）和癌症都是常见疾病，它们经常在同一患者中同时发生。我们研究了与基线 DM、他汀类药物使用和二甲双胍使用相关的全因和特定原因死亡率动态。研究人群由来自芬兰的 39900 例新发癌症病例组成，19822 例患者在随访开始时无 DM，20078 例患者有 DM。使用泊松回归模型分析全因、癌症、心血管（CVD）和其他原因的死亡率，模型中包含以下变量：性别、年龄、DM、基线时他汀类药物和二甲双胍的使用情况、癌症类型和分期以及日历时期。他汀类药物的使用与癌症特异性死亡率降低相关，发病率比（IRR）为 0.72（95%置信区间 0.69-0.74），CVD 死亡率的 IRR 为 0.95（0.88-1.02），其他原因死亡率的 IRR 为 0.64（0.56-0.74）。在 DM 患者的亚组中，全因死亡率的二甲双胍 IRR 为 0.74（0.71-0.78），癌症死亡率的 IRR 为 0.75（0.72-0.79），CVD 死亡率的 IRR 为 0.75（0.68-0.83），其他原因死亡率的 IRR 为 0.68（0.60-0.78）。总之，我们基于登记的癌症诊断后生存研究表明，患有糖尿病的患者在所有指标上的预后都明显较差。基线他汀类药物使用与全因、癌症和心血管死亡率降低之间的关联，受到癌症类型的影响。他汀类药物对乳腺癌和结直肠癌的影响最大。在口服抗糖尿病药物使用者的亚组中，二甲双胍的使用通常与较低的死亡率相关，但这种关联受到癌症类型的影响。这种关联在肝癌、结直肠癌和乳腺癌最强。
