Cao Xun, Wu Yaopan, Wang Jing, Liu Kuiyuan, Wang Xin
Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong, China (XC, YPW, JW, KYL, XW); Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China (KYL, XW).
JNCI Cancer Spectr. 2017 Nov 28;1(1):pkx007. doi: 10.1093/jncics/pkx007. eCollection 2017 Sep.
Most data suggest that cancer patients with diabetes have worse outcomes, which may be reversed with metformin. Metformin might modulate the clinical outcomes of diabetic cancer patients. We performed a systematic review and meta-analysis based on published studies over the past five years to summarize the effects of metformin on diabetic cancer patients.
We systematically searched for studies that were published over the past five years. Then, we evaluated these studies for inclusion and extracted the relevant data. The summary risk estimates for the association between metformin treatment and all-cause mortality (ACM) and cancer-specific mortality (CSM) were analyzed using random or fixed-effects models. Stratified analyses by cancer site and country were also conducted.
Based on the 42 studies included in our analysis (37 015 diabetic cancer patients), we found a significant benefit associated with metformin treatment on survival corresponding to 27% and 26% reductions in ACM (hazard ratio [HR] = 0.73, 95% confidence interval [CI] = 0.68 to 0.79, < .001) and CSM (HR = 0.74, 95% CI = 0.64 to 0.86, < .001), respectively. The ACM rates for colorectal cancer, endometrial cancer, breast cancer, prostate cancer, and ovarian cancer showed significant benefits associated with metformin treatment in our stratified analyses by cancer site. Stratified analyses by cancer site also showed a significant reduction in CSM for breast cancer. This association between metformin treatment and reduced CSM for diabetic breast cancer patients was also observed in our country subgroup analyses.
We found an association between metformin exposure and reduced ACM and CSM in diabetic patients with cancer. Our findings suggest that metformin treatment could be an effective treatment option for diabetic cancer patients.
大多数数据表明，糖尿病癌症患者的预后较差，而二甲双胍可能会改善这一情况。二甲双胍可能会调节糖尿病癌症患者的临床结局。我们基于过去五年发表的研究进行了一项系统评价和荟萃分析，以总结二甲双胍对糖尿病癌症患者的影响。
我们系统检索了过去五年发表的研究。然后，我们评估这些研究是否纳入，并提取相关数据。使用随机或固定效应模型分析二甲双胍治疗与全因死亡率（ACM）和癌症特异性死亡率（CSM）之间关联的汇总风险估计值。还按癌症部位和国家进行了分层分析。
基于我们分析中纳入的42项研究（37015例糖尿病癌症患者），我们发现二甲双胍治疗与生存获益显著相关，ACM降低了27%，CSM降低了26%（风险比[HR]=0.73，95%置信区间[CI]=0.68至0.79，P<.001）和（HR=0.74，95%CI=0.64至0.86，P<.001）。在我们按癌症部位进行的分层分析中，结直肠癌、子宫内膜癌、乳腺癌、前列腺癌和卵巢癌的ACM率显示与二甲双胍治疗显著相关。按癌症部位进行的分层分析还显示乳腺癌的CSM显著降低。在我们的国家亚组分析中也观察到二甲双胍治疗与糖尿病乳腺癌患者CSM降低之间的这种关联。
我们发现二甲双胍暴露与糖尿病癌症患者的ACM和CSM降低之间存在关联。我们的研究结果表明，二甲双胍治疗可能是糖尿病癌症患者的一种有效治疗选择。
