二甲双胍对晚期非小细胞肺癌的预后价值：一项系统评价和荟萃分析。
The prognostic value of metformin for advanced non-small cell lung cancer: a systematic review and meta-analysis.
作者信息
Zhang Jianrong, Wu Jieyu, He Qihua, Liang Wenhua, He Jianxing
机构信息
George Warren Brown School, Washington University in St. Louis, St. Louis, USA.
Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.
出版信息
Transl Lung Cancer Res. 2018 Jun;7(3):389-396. doi: 10.21037/tlcr.2018.03.14.
BACKGROUND
The prognostic value of Metformin for concurrent non-small cell lung cancer (NSCLC) has been controversial in previous individual studies and meta-analyses. In order to further investigate the value of this medication, we conducted a systematic review and meta-analysis for patients with advanced or inoperable NSCLC.
METHODS
We searched articles from PubMed, Scopus and Web of Science databases; the time interval was from the inception date of the databases to 1 September 2017. Inclusion criteria for eligible studies were: advanced or inoperable NSCLC; Metformin as an experimental group, and non-Metformin usage as a control group; progression-free survival (PFS) or overall survival (OS) as the outcome, with available hazard ratio (HR). Data synthesis was conducted based on the random-effect model.
RESULTS
From a total of 97 articles in databases, we included seven eligible studies. Among them, only one study compared Metformin usage and non-Metformin usage for NSCLC patients who didn't have diabetes mellitus (DM): no significant difference was found in either OS or PFS. The remaining six studies compared Metformin usage and non-Metformin usage for patients with concurrent NSCLC and DM: according to meta-analysis, significantly prolonged OS was found in Metformin usage rather than non-Metformin usage [pooled HR =0.87 (0.77-0.99), P=0.04]; no significant difference was indicated in PFS [pooled HR =0.85 (0.67-1.07), P=0.16]. In subgroup analysis, among patients with late-stage NSCLC and DM, significant difference was found, regardless of OS [pooled HR =0.81 (0.70-0.94), P<0.01] or PFS [pooled HR =0.71 (0.58-0.88), P<0.01]. However, among patients with local advanced NSCLC and DM, there was no significant difference [OS: pooled HR =1.05 (0.79-1.40), P=0.74; PFS: pooled HR =0.94 (0.68-1.32), P=0.74].
CONCLUSIONS
The prognostic value of Metformin for concurrent late-stage NSCLC and DM was demonstrated. It deserves further confirmation and explanation.
背景
在既往的个体研究和荟萃分析中，二甲双胍对合并非小细胞肺癌（NSCLC）患者的预后价值一直存在争议。为了进一步探究这种药物的价值，我们对晚期或无法手术的NSCLC患者进行了一项系统评价和荟萃分析。
方法
我们检索了PubMed、Scopus和Web of Science数据库中的文章；时间间隔为从数据库建立之日至2017年9月1日。纳入合格研究的标准为：晚期或无法手术的NSCLC；以二甲双胍作为实验组，未使用二甲双胍作为对照组；以无进展生存期（PFS）或总生存期（OS）作为结局指标，且有可用的风险比（HR）。基于随机效应模型进行数据合成。
结果
在数据库中的97篇文章中，我们纳入了7项合格研究。其中，只有1项研究比较了未患糖尿病（DM）的NSCLC患者使用二甲双胍与未使用二甲双胍的情况：在OS或PFS方面均未发现显著差异。其余6项研究比较了合并NSCLC和DM的患者使用二甲双胍与未使用二甲双胍的情况：根据荟萃分析，发现使用二甲双胍组的OS显著延长，而非未使用二甲双胍组[合并HR =0.87（0.77 - 0.99），P =0.04]；PFS方面未显示出显著差异[合并HR =0.85（0.67 - 1.07），P =0.16]。在亚组分析中，在晚期NSCLC合并DM的患者中，无论OS[合并HR =0.81（0.70 - 0.94），P <0.01]还是PFS[合并HR =0.71（0.58 - 0.88），P <0.01]均发现有显著差异。然而，在局部晚期NSCLC合并DM的患者中，未发现显著差异[OS：合并HR =1.05（0.79 - 1.40），P =0.74；PFS：合并HR =0.94（0.68 - 1.32），P =0.74]。
结论
证实了二甲双胍对合并晚期NSCLC和DM患者的预后价值。值得进一步证实和解释。
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