二甲双胍与局部晚期直肠癌新辅助放化疗反应改善是否相关？

Is Metformin Associated With Improved Response to Neoadjuvant Chemoradiotherapy in Locally Advanced Rectal Cancer?

作者信息

Planellas Pere, Cornejo Lidia, Rodríguez-Hermosa Jose Ignacio, Maldonado Eloy, Timoteo Ander, Hernández-Yagüe Xavier, Farrés Ramon, Codina-Cazador Antoni

机构信息

Department of General and Digestive Surgery, University Hospital of Girona; Department of Medical Sciences, Faculty of Medicine, University of Girona, Girona Biomedical Research Institute (IDIBGI), Girona, Spain.

Girona Biomedical Research Institute (IDIBGI) Girona - Surgery Research Group, Spain.

出版信息

J Surg Res. 2021 Dec;268:465-473. doi: 10.1016/j.jss.2021.06.079. Epub 2021 Aug 18.

DOI:10.1016/j.jss.2021.06.079

PMID:34418650

Abstract

BACKGROUND

Efforts to determine whether metformin can increase the effectiveness of neoadjuvant chemoradiotherapy in rectal cancer have increased in recent years. However, retrospective studies have yielded inconclusive results.

OBJECTIVES

The aim of this study was to compare oncological outcomes and survival after neoadjuvant chemoradiotherapy in patients with rectal cancer taking metformin versus in those not taking metformin.

METHODS

This study analyzed 423 consecutive patients with locally advanced rectal cancer who underwent neoadjuvant chemoradiotherapy and curative surgery between January 2010 and May 2020; of these, 59 were taking metformin and 364 were not taking metformin.

RESULTS

Patients taking metformin had a lower proportion of tumor regression (6.8% versus 22.0%, P = 0.012) as well as a lower proportion of patients achieving a pathological complete response (6.8% versus 20.6%, P = 0.011). In the multivariate analysis, independent predictors of pathologic complete response were not taking metformin (OR: 5.26, 95% CI: 1.12-24.85, P= 0.035) and cT2 stage (OR: 3.49, 95% CI: 1.10-11.07, P= 0.034); the interval was also an independent predictor of tumor regression (OR: 1.78, 95% CI: 1.06-2.96, P= 0.028). No differences were observed in survival between groups.

CONCLUSION

Metformin was not associated with better tumor responses or survival after neoadjuvant treatment.

摘要

背景

近年来，确定二甲双胍是否能提高直肠癌新辅助放化疗疗效的研究不断增加。然而，回顾性研究结果尚无定论。

目的

本研究旨在比较服用二甲双胍与未服用二甲双胍的直肠癌患者新辅助放化疗后的肿瘤学结局和生存率。

方法

本研究分析了2010年1月至2020年5月期间连续接受新辅助放化疗及根治性手术的423例局部晚期直肠癌患者；其中，59例服用二甲双胍，364例未服用二甲双胍。

结果

服用二甲双胍的患者肿瘤退缩比例较低（6.8%对22.0%，P = 0.012），达到病理完全缓解的患者比例也较低（6.8%对20.6%，P = 0.011）。多因素分析中，病理完全缓解的独立预测因素为未服用二甲双胍（OR：5.26，95%CI：1.12 - 24.85，P = 0.035）和cT2期（OR：3.49，95%CI：1.10 - 11.07，P = 0.034）；时间间隔也是肿瘤退缩的独立预测因素（OR：1.78，95%CI：1.06 - 2.96，P = 0.028）。两组间生存率未观察到差异。