De Monte Ariella, Brunetti Davide, Cattin Luigi, Lavanda Francesca, Naibo Erica, Malagoli Maria, Stanta Giorgio, Bonin Serena
Unit of Medical Clinic, University Hospital of Cattinara-ASUITS, I-34149 Trieste, Italy.
Department of Medical Sciences, University of Trieste, Cattinara Hospital, I-34149 Trieste, Italy.
Mol Clin Oncol. 2018 Mar;8(3):504-512. doi: 10.3892/mco.2018.1554. Epub 2018 Jan 11.
Metformin, the drug of choice in the treatment of type 2 diabetes mellitus (DM2), in addition to aspirin (ASA), the drug prescribed for cardioprotection of diabetic and non-diabetic patients, have an inhibitory effect on cancer cell survival. The present population-based study conducted in the province of Trieste (Italy), aimed to investigate the prevalence of DM2 in patients with colorectal adenocarcinoma (CRC) and survival for CRC in diabetic and nondiabetic patients. All permanent residents diagnosed with a CRC between 2004 and 2007 were ascertained through the regional health information system. CRC-specific and relative survival probabilities were computed for each group of patients defined by CRC stage, presence or absence of DM2 treated with metformin, and presence or absence of daily ASA therapy. A total of 515 CRC patients without DM2 and 156 with DM2 treated with metformin were enrolled in the study. At the time of CRC diagnosis, 71 (14%) nondiabetic and 39 (25%) diabetic patients were taking ASA daily. The five-year relative survival for stage III CRC was 101% [95% confidence interval (CI)=76-126] in the 18 patients with DM2 treated with metformin and ASA, 55% (95% CI=31-78) in the 23 without DM2 treated with ASA, 55% (95% CI=45-65) in the 150 without DM2 not taking ASA, and 29% (95% CI=13-45) in the 43 with DM2 treated with metformin, however not with ASA. The findings support the hypothesis of a possible inhibitory effect of metformin and ASA on CRC cells. Randomized controlled trials are required to verify this hypothesis.
二甲双胍是治疗2型糖尿病（DM2）的首选药物，除了阿司匹林（ASA），后者是为糖尿病和非糖尿病患者进行心脏保护而开具的药物，它们对癌细胞存活具有抑制作用。在意大利的里雅斯特省进行的这项基于人群的研究，旨在调查结直肠癌（CRC）患者中DM2的患病率以及糖尿病和非糖尿病患者中CRC的生存率。通过区域健康信息系统确定了2004年至2007年间所有被诊断为CRC的永久居民。计算了由CRC分期、是否使用二甲双胍治疗DM2以及是否进行每日ASA治疗所定义的每组患者的CRC特异性和相对生存概率。共有515名无DM2的CRC患者和156名使用二甲双胍治疗的DM2患者纳入研究。在CRC诊断时，71名（14%）非糖尿病患者和39名（25%）糖尿病患者每天服用ASA。在18名接受二甲双胍和ASA治疗的DM2患者中，III期CRC的五年相对生存率为101% [95%置信区间（CI）=76 - 126]；在23名未患DM2但接受ASA治疗的患者中为55%（95% CI = 31 - 78）；在150名未患DM2且未服用ASA的患者中为55%（95% CI = 45 - 65）；在43名接受二甲双胍治疗但未使用ASA的DM2患者中为29%（95% CI = 13 - 45）。这些发现支持了二甲双胍和ASA可能对CRC细胞具有抑制作用的假设。需要进行随机对照试验来验证这一假设。
