College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, Seoul.
Department of Information & Statistics, Chungbuk National University, 1 Chungdae-ro, Seowon-gu, Chungbuk.
Medicine (Baltimore). 2021 Mar 19;100(11):e25045. doi: 10.1097/MD.0000000000025045.
Malignant neoplasms are the leading cause of death in Korea. We aimed to examine if metformin use in cancer survivors reduces all-cause mortality. This study was retrospectively designed based on data from the Korean National Health Insurance Service-National Health Screening Cohort (HEALS) between 2002 and 2015. The Kaplan-Meier estimator and log-rank test was performed to estimate the survival function according to metformin usage (3721 metformin non-users with diabetes, 5580 metformin users with diabetes, and 24,483 non-diabetic individuals). Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality were calculated using Cox proportional hazards regression models.The median follow-up duration was 4.2 years. The HRs (95% CIs) for all-cause mortality of metformin users and the non-diabetic group were 0.762 (0.683-0.850) and 1.055 (0.966-1.152) in men and 0.805 (0.649-0.999), and 1.049 (0.873-1.260) in women, respectively, compared with metformin non-users among diabetic cancer survivors, in a fully adjusted model. After stratifying metformin users into pre- and post-diagnosis of cancers, adjusted HRs (95% CIs) of pre- and post-diagnosis metformin users for all-cause mortality were 0.948 (0.839-1.071) and 0.530 (0.452-0.621) in men and 1.163 (0.921-1.469) and 0.439 (0.323-0.596) in women, respectively.Metformin use in cancer survivors with diabetes reduced overall mortality rates. In particular, metformin use after cancer diagnosis, not before cancer diagnosis, was inversely associated with overall mortality.Active treatment with metformin for diabetic cancer survivors after cancer diagnosis can improve their survival rates.
恶性肿瘤是韩国死亡的主要原因。我们旨在研究癌症幸存者中使用二甲双胍是否降低全因死亡率。这项研究是基于 2002 年至 2015 年韩国国家健康保险服务-国家健康筛查队列（HEALS）的数据进行的回顾性设计。Kaplan-Meier 估计器和对数秩检验用于根据二甲双胍使用情况（3721 名糖尿病二甲双胍未使用者、5580 名糖尿病二甲双胍使用者和 24483 名非糖尿病个体）估计生存函数。使用 Cox 比例风险回归模型计算全因死亡率的调整后的危险比（HR）和 95%置信区间（CI）。中位随访时间为 4.2 年。在调整后的模型中，与糖尿病癌症幸存者中的二甲双胍未使用者相比，男性中二甲双胍使用者和非糖尿病组的全因死亡率 HR（95%CI）分别为 0.762（0.683-0.850）和 1.055（0.966-1.152），女性中分别为 0.805（0.649-0.999）和 1.049（0.873-1.260）。在将二甲双胍使用者分层为癌症诊断前和诊断后后，调整后的全因死亡率 HR（95%CI）在男性中分别为诊断前和诊断后二甲双胍使用者的 0.948（0.839-1.071）和 0.530（0.452-0.621），女性中分别为 1.163（0.921-1.469）和 0.439（0.323-0.596）。癌症幸存者中使用二甲双胍可降低总体死亡率。特别是，癌症诊断后而不是诊断前使用二甲双胍与总体死亡率呈负相关。癌症诊断后积极治疗糖尿病癌症幸存者的二甲双胍可以提高他们的生存率。
