Xin Wenxiu, Fang Luo, Fang Qilu, Zheng Xiaowei, Huang Ping
Laboratory of Clinical Pharmacy, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, P.R. China.
Key Laboratory of Head and Neck Cancer Translational Research of Zhejiang Province, Hangzhou, Zhejiang 310022, P.R. China.
Mol Clin Oncol. 2018 Mar;8(3):483-488. doi: 10.3892/mco.2017.1541. Epub 2017 Dec 20.
Pancreatic cancer risk is reduced by metformin treatment in patients with diabetes. However, the effect of metformin on pancreatic cancer overall survival is unclear. The aim of the present study was to determine the association between metformin and clinical outcomes of pancreatic cancer patients with diabetes. An electronic and manual search was conducted using PubMed, Web of Science, Medline-Ovid and Cochrane Library databases between the beginning and March 31, 2017. A total of 8 studies consisting of 4,293 patients with pancreatic cancer with diabetes were included, comprising 2,033 patients who had received metformin and 2,260 patients who had not. The meta-analysis showed that metformin was associated with a relative survival benefit in pancreatic cancer patients [hazard ratio (HR), 0.81; 95% confidence interval (CI), 0.70-0.93]. These associations were also observed in subgroups of Asian countries 0.64 (95% CI, 0.52-0.80) and Western countries 0.88 (95% CI, 0.82-0.95), as well as diabetes (no indication of diabetes type). Excluding the studies considered as be prone to immortal time bias resulted in HRs (95% CIs) of 0.86 (0.69-1.07). The results of this study support the notion that the use of metformin may improve the overall survival of patients with pancreatic cancer with concurrent diabetes. However, the proposed beneficial effect of metformin on pancreatic cancer survival may be based on immortal time bias. Further carefully designed studies with high quality are warranted to confirm this efficacy.
二甲双胍治疗可降低糖尿病患者患胰腺癌的风险。然而，二甲双胍对胰腺癌总生存期的影响尚不清楚。本研究的目的是确定二甲双胍与糖尿病胰腺癌患者临床结局之间的关联。于2017年年初至3月31日期间，使用PubMed、Web of Science、Medline - Ovid和Cochrane图书馆数据库进行了电子和人工检索。共纳入8项研究，包括4293例糖尿病胰腺癌患者，其中2033例接受了二甲双胍治疗，2260例未接受。荟萃分析表明，二甲双胍与胰腺癌患者的相对生存获益相关[风险比(HR)，0.81；95%置信区间(CI)，0.70 - 0.93]。在亚洲国家亚组[0.64(95%CI，0.52 - 0.80)]和西方国家亚组[0.88(95%CI,0.82 - 0.95)]以及糖尿病患者(未表明糖尿病类型)中也观察到了这些关联。排除被认为易出现不朽时间偏倚的研究后，HR(95%CI)为0.86(0.69 - 1.07)。本研究结果支持使用二甲双胍可能改善合并糖尿病的胰腺癌患者总生存期这一观点。然而，二甲双胍对胰腺癌生存的拟有益作用可能基于不朽时间偏倚。需要进一步开展精心设计的高质量研究来证实这种疗效。
