Wu Jinqing, Zhou Yabo, Wang Guizhou
Department of Gastroenterology, Fuyang People's Hospital, Fuyang 236000, China.
Gastroenterol Res Pract. 2021 Oct 29;2021:9468227. doi: 10.1155/2021/9468227. eCollection 2021.
Metformin is an oral antidiabetic agent that has been widely prescribed for the treatment of type II diabetes. In recent years, anticancer properties of metformin have been revealed for numerous human malignancies. However, there are few indications available regarding the feasibility and safety of these studies in an advanced extrahepatic cholangiocarcinoma (EHCC) population. This study is aimed at evaluating the feasibility, safety, and value of metformin use and survival in patients with advanced EHCC.
All patients with advanced EHCC observed at Fuyang People's Hospital between January 2015 and November 2020 were included in the study. Case data, clinical information, and imaging results were abstracted from the self-administered questionnaire and electronic medical record. All patients were divided into study subjects and control subjects, and the study subjects were given metformin, 0.5 g, three times a day, while control subjects were without metformin. The metformin use and survival time of the subjects were asked by telephone, out-patient, or door-to-door visit, after they left the hospital.
One hundred and thirty-three study cases and 589 controls were included in the analysis. This study showed that metformin use cannot improve the overall survival rate of patients with advanced EHCC ([95% CI]: -17.05-0.375, = -1.889, value = 0.061), but the survival time of patients with drainage treatment from control group ( = 496) was significantly shorter than that of patients with drainage treatment from the study group ( = 113), and the difference was statistically significant ( = -2.230, value = 0.026). There were significant differences between metformin used before or after the diagnosis of advanced EHCC (OR[95% CI], 3.432[2.617-4.502]; value = 0.001) in survival time. And there was significant difference between the duration of metformin use and survival prognosis (OR[95% CI], 2.967[1.383-6.368]; = 0.005).
Metformin can improve the survival of advanced EHCC patients who underwent drainage treatment, especially for metformin use after diagnosis of advanced EHCC and long duration of metformin.
二甲双胍是一种口服抗糖尿病药物，已被广泛用于治疗II型糖尿病。近年来，二甲双胍对多种人类恶性肿瘤的抗癌特性已被揭示。然而，关于这些研究在晚期肝外胆管癌（EHCC）患者中的可行性和安全性的相关指征却很少。本研究旨在评估二甲双胍在晚期EHCC患者中的使用可行性、安全性、价值及生存期。
纳入2015年1月至2020年11月在阜阳市人民医院观察的所有晚期EHCC患者。病例数据、临床信息和影像结果从自填问卷和电子病历中提取。所有患者分为研究对象和对照对象，研究对象给予二甲双胍，0.5g，每日三次，而对照对象不使用二甲双胍。在患者出院后，通过电话、门诊或上门访视询问受试者二甲双胍的使用情况和生存时间。
分析纳入133例研究病例和589例对照。本研究表明，使用二甲双胍不能提高晚期EHCC患者的总生存率（[95%CI]：-17.05-0.375，=-1.889，P值=0.061），但对照组（=496）接受引流治疗患者的生存时间明显短于研究组（=113）接受引流治疗患者的生存时间，差异有统计学意义（=-2.230，P值=0.026）。晚期EHCC诊断前后使用二甲双胍在生存时间上有显著差异（OR[95%CI]，3.432[2.617-4.502]；P值=0.001）。二甲双胍使用时长与生存预后之间有显著差异（OR[95%CI]，2.967[1.383-6.368]；=0.005）。
二甲双胍可提高接受引流治疗的晚期EHCC患者的生存率，特别是晚期EHCC诊断后使用二甲双胍且使用时间较长的患者。
