Seo Seung In, Kim Tae Jun, Park Chan Hyuk, Bang Chang Seok, Lee Kyung Joo, Kim Jinseob, Kim Hyon Hee, Shin Woon Geon
Division of Gastroenterology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 445, Gil-dong, Kangdong-gu, Seoul 05355, Korea.
Institute for Liver and Digestive Diseases, Hallym University, Chuncheon 24252, Korea.
J Pers Med. 2022 Apr 5;12(4):584. doi: 10.3390/jpm12040584.
Previous studies have reported that metformin use in patients with diabetes mellitus may reduce the risk of colorectal cancer (CRC) incidence and prognosis; however, the evidence is not definite. This population-based cohort study aimed to investigate whether metformin reduces the risk of CRC incidence and prognosis in patients with diabetes mellitus using a common data model of the Korean National Health Insurance Service database from 2002 to 2013.
Patients who used metformin for at least 6 months were defined as metformin users. The primary outcome was CRC incidence, and the secondary outcomes were the all-cause and CRC-specific mortality. Cox proportional hazard model was performed and large-scaled propensity score matching was used to control for potential confounding factors.
During the follow-up period of 81,738 person-years, the incidence rates (per 1000 person-years) of CRC were 5.18 and 8.12 in metformin users and non-users, respectively ( = 0.001). In the propensity score matched cohort, the risk of CRC incidence in metformin users was significantly lower than in non-users (hazard ratio (HR), 0.58; 95% CI (confidence interval), 0.47-0.71). In the sensitivity analysis, the lag period extending to 1 year showed similar results (HR: 0.63, 95% CI: 0.51-0.79). The all-cause mortality was significantly lower in metformin users than in non-users (HR: 0.71, 95% CI: 0.64-0.78); CRC-related mortality was also lower among metformin users. However, there was no significant difference (HR: 0.55, 95% CI: 0.26-1.08).
Metformin use was associated with a reduced risk of CRC incidence and improved overall survival.
既往研究报道，糖尿病患者使用二甲双胍可能降低结直肠癌（CRC）的发病风险及改善预后；然而，证据并不确凿。这项基于人群的队列研究旨在利用韩国国民健康保险服务数据库2002年至2013年的通用数据模型，调查二甲双胍是否能降低糖尿病患者患CRC的风险及改善预后。
使用二甲双胍至少6个月的患者被定义为二甲双胍使用者。主要结局是CRC发病率，次要结局是全因死亡率和CRC特异性死亡率。采用Cox比例风险模型，并使用大规模倾向评分匹配来控制潜在的混杂因素。
在81738人年的随访期内，二甲双胍使用者和非使用者的CRC发病率（每1000人年）分别为5.18和8.12（P = 0.001）。在倾向评分匹配队列中，二甲双胍使用者患CRC的风险显著低于非使用者（风险比（HR），0.58；95%置信区间（CI），0.47 - 0.71）。在敏感性分析中，将滞后时间延长至1年显示出相似的结果（HR：0.63，95% CI：0.51 - 0.79）。二甲双胍使用者的全因死亡率显著低于非使用者（HR：0.71，95% CI：0.64 - 0.78）；二甲双胍使用者中与CRC相关的死亡率也较低。然而，差异无统计学意义（HR：0.55，95% CI：0.26 - 1.08）。
使用二甲双胍与降低CRC发病风险及改善总体生存率相关。
