Division of Epidemiology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA.
Tongren Hospital, Shanghai Jiao Tong University, Shanghai, China.
Cancer Res Treat. 2019 Apr;51(2):538-546. doi: 10.4143/crt.2017.591. Epub 2018 Jul 2.
Studies suggest that regular use of metformin may decrease cancer mortality. We investigated the association between diabetes medication use and cancer survival.
The current study includes 633 breast, 890 colorectal, 824 lung, and 543 gastric cancer cases identified from participants of two population-based cohort studies in Shanghai. Information on diabetes medication use was obtained by linking to electronic medical records. The associations between diabetes medication use (metformin, sulfonylureas, and insulin) and overall and cancer-specific survival were evaluated using time-dependent Cox proportional hazards models.
After adjustment for clinical characteristics and treatment factors, use of metformin was associated with better overall survival among colorectal cancer patients (hazards ratio [HR], 0.55; 95% confidence interval [CI], 0.34 to 0.88) and for all four types of cancer combined (HR, 0.75; 95% CI, 0.57 to 0.98). Ever use of insulin was associated with worse survival for all cancer types combined (HR, 1.89; 95% CI, 1.57 to 2.29) and for the four cancer types individually. Similar associations were seen for diabetic patients. Sulfonylureas use was associated with worse overall survival for breast or gastric cancer (HR, 2.87; 95% CI, 1.22 to 6.80 and HR, 2.05; 95% CI, 1.09 to 3.84, respectively) among diabetic patients. Similar association patterns were observed between diabetes medication use and cancer-specific survival.
Metformin was associated with improved survival among colorectal cancer cases, while insulin use was associated with worse survival among patients of four major cancers. Further investigation on the topic is needed given the potential translational impact of these findings.
研究表明，经常使用二甲双胍可能会降低癌症死亡率。我们调查了糖尿病药物使用与癌症生存之间的关系。
本研究纳入了 633 例乳腺癌、890 例结直肠癌、824 例肺癌和 543 例胃癌病例，这些病例均来自上海两项基于人群的队列研究的参与者。通过与电子病历链接获取糖尿病药物使用信息。使用时依 Cox 比例风险模型评估糖尿病药物（二甲双胍、磺酰脲类和胰岛素）使用与总生存和癌症特异性生存之间的关联。
在调整临床特征和治疗因素后，与所有四种癌症合并（风险比 [HR]，0.75；95%置信区间 [CI]，0.57 至 0.98）相比，结直肠癌患者使用二甲双胍与更好的总生存相关（HR，0.55；95%CI，0.34 至 0.88）。胰岛素的使用与所有癌症类型的总生存不良相关（HR，1.89；95%CI，1.57 至 2.29）和所有四种癌症类型的个体相关。在糖尿病患者中也观察到类似的关联。对于乳腺癌或胃癌患者（HR，2.87；95%CI，1.22 至 6.80 和 HR，2.05；95%CI，1.09 至 3.84），磺酰脲类药物的使用与总生存不良相关。在糖尿病患者中，糖尿病药物使用与癌症特异性生存之间也观察到类似的关联模式。
二甲双胍与结直肠癌病例的生存改善相关，而胰岛素的使用与四种主要癌症患者的生存恶化相关。鉴于这些发现具有潜在的转化意义，需要对此进行进一步研究。
