Arima R, Hautakoski A, Marttila M, Arffman M, Sund R, Ilanne-Parikka P, Kangaskokko J, Hinkula M, Puistola U, Läärä E
Department of Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu and University Hospital of Oulu, P.O. Box 23, FIN-90029 Oulu, Finland.
Children, Adolescents and Families Unit, Department of Welfare, National Institute for Health and Welfare, P.O. Box 310, FIN-90101 Oulu, Finland.
Gynecol Oncol. 2017 Dec;147(3):678-683. doi: 10.1016/j.ygyno.2017.10.014. Epub 2017 Oct 18.
To obtain further evidence of the association between metformin or other types of antidiabetic medication (ADM) and mortality from endometrial cancer (EC) and other causes of death in patients with endometrioid EC and type 2 diabetes (T2D).
A retrospective cohort of women with existing T2D and diagnosed with endometrioid EC from 1998 to 2011, obtained from a nationwide diabetes database (FinDM), were included in the study. Cumulative mortality from EC and that from other causes was described by using the Aalen-Johansen estimator. Cause-specific mortality rates were analyzed by using Cox models, and adjusted hazard ratios (HRs) with 95% confidence intervals (95% CIs) were estimated in relation to the use of different forms of ADM during the three-year period preceding EC diagnosis.
From the FinDM cohort we identified 1215 women diagnosed with endometrioid EC, of whom 19% were metformin users, 12% were users of other types of oral antidiabetic medication, 25% used other types of oral antidiabetic medication plus metformin, 26% used insulin and 14% had no antidiabetic medication. Mortality from EC was not found to be different in women using metformin (HR 0.89, 95% Cl 0.52-1.54) but mortality from other causes was lower (HR 0.52, 95% Cl 0.31-0.88) compared with women using other types of oral ADM.
Our findings are inconclusive as to the possible effect of metformin on the prognosis of endometrioid EC in women with T2D. However, use of metformin may reduce mortality from other causes.
获取二甲双胍或其他类型抗糖尿病药物（ADM）与子宫内膜样癌（EC）患者的子宫内膜癌死亡率及其他死因之间关联的进一步证据，这些患者患有子宫内膜样癌和2型糖尿病（T2D）。
本研究纳入了1998年至2011年从全国糖尿病数据库（FinDM）中获取的患有T2D且被诊断为子宫内膜样癌的女性回顾性队列。使用Aalen-Johansen估计量描述EC的累积死亡率和其他原因导致的累积死亡率。通过Cox模型分析特定病因死亡率，并估计在EC诊断前三年期间使用不同形式ADM的调整风险比（HR）及95%置信区间（95%CI）。
从FinDM队列中，我们识别出1215名被诊断为子宫内膜样癌的女性，其中19%使用二甲双胍，12%使用其他类型口服抗糖尿病药物，25%同时使用其他类型口服抗糖尿病药物和二甲双胍，26%使用胰岛素，14%未使用抗糖尿病药物。使用二甲双胍的女性中，EC死亡率无差异（HR 0.89，95%CI 0.52 - 1.54），但与使用其他类型口服ADM的女性相比，其他原因导致的死亡率较低（HR 0.52，95%CI 0.31 - 0.88）。
我们的研究结果对于二甲双胍对T2D女性子宫内膜样癌预后的可能影响尚无定论。然而，使用二甲双胍可能降低其他原因导致的死亡率。
