二甲双胍与结直肠癌：系统评价、荟萃分析和荟萃回归。

Metformin and colorectal cancer: a systematic review, meta-analysis and meta-regression.

机构信息

Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore.

Department of Haematology-Oncology, National University Cancer Institute, NUH Medical Centre, Singapore, 119074, Singapore.

出版信息

Int J Colorectal Dis. 2020 Aug;35(8):1501-1512. doi: 10.1007/s00384-020-03676-x. Epub 2020 Jun 26.

DOI:10.1007/s00384-020-03676-x

PMID:32592092

Abstract

PURPOSE

Metformin may have a role in reducing the incidence of colorectal cancer (CRC) and improving survival outcome. This meta-analysis explored the effect of metformin use on colorectal adenoma and cancer incidence, and colorectal oncological outcomes.

METHODS

A database search was conducted on Medline, Embase and CNKI for studies comparing metformin vs. non-metformin users, metformin users vs. non-diabetics and metformin users vs. diabetics with diet-only treatment. Meta-analysis was done with DerSimonian and Laird with risk ratios (RR), and hazard ratios (HR) for survival outcomes.

RESULTS

We included 58 studies and summarized incidences of colorectal adenoma and cancer, as well as cancer survival outcomes. Metformin users had a significant lower incidence of colorectal adenoma (RR 0.77, CI 0.67-0.88, p < 0.001), advanced adenoma (0.61, CI 0.42-0.88, p = 0.008) and CRC (RR 0.76, CI 0.69-0.84, p < 0.001) respectively compared with non-metformin users. Overall survival (HR 0.6, CI 0.53-0.67, p < 0.001) and CRC-specific survival (HR 0.66, CI 0.59-0.74, p < 0.001) were higher among metformin users compared with non-metformin users. Further analysis on overall survival of metastatic CRC patients revealed significantly higher survival rates in metformin users (HR 0.77, CI 0.68-0.87, p < 0.001).

CONCLUSION

This meta-analysis showed that metformin use significantly reduces colorectal adenoma and cancer incidence and improves colorectal cancer outcomes.

摘要

目的

二甲双胍可能在降低结直肠癌（CRC）的发生率和改善生存结局方面发挥作用。本荟萃分析探讨了二甲双胍的使用对结直肠腺瘤和癌症发生率以及结直肠肿瘤学结局的影响。

方法

对 Medline、Embase 和中国知网（CNKI）数据库进行检索，比较了二甲双胍与非二甲双胍使用者、二甲双胍使用者与非糖尿病患者以及二甲双胍使用者与仅饮食治疗的糖尿病患者的研究。采用 DerSimonian 和 Laird 进行荟萃分析，计算风险比（RR）和生存结局的风险比（HR）。

结果

我们纳入了 58 项研究，总结了结直肠腺瘤和癌症的发生率以及癌症生存结局。与非二甲双胍使用者相比，二甲双胍使用者结直肠腺瘤（RR 0.77，CI 0.67-0.88，p<0.001）、高级别腺瘤（0.61，CI 0.42-0.88，p=0.008）和 CRC（RR 0.76，CI 0.69-0.84，p<0.001）的发生率显著降低。与非二甲双胍使用者相比，二甲双胍使用者的总生存（HR 0.6，CI 0.53-0.67，p<0.001）和 CRC 特异性生存（HR 0.66，CI 0.59-0.74，p<0.001）更高。对转移性 CRC 患者总生存的进一步分析显示，二甲双胍使用者的生存率显著提高（HR 0.77，CI 0.68-0.87，p<0.001）。