Laffusa Alice, Ciaccio Antonio, Elvevi Alessandra, Gallo Camilla, Ratti Laura, Invernizzi Pietro, Massironi Sara
Division of Gastroenterology and Center for Autoimmune Liver Diseases, San Gerardo Hospital and Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
Eur J Gastroenterol Hepatol. 2023 Mar 1;35(3):241-247. doi: 10.1097/MEG.0000000000002503. Epub 2022 Dec 23.
Cholangiocarcinoma (CCA) is the second most common liver cancer. Diabetes is a well-known risk factor; however, treatment with metformin has been reported to be protective for several cancers, but data on CCA are still sparse and heterogeneous. We performed this meta-analysis to investigate the role of metformin as a potential protective factor for CCA. In this systematic review and meta-analysis, we searched PubMed/MEDLINE and EMBASE databases, from the date of inception to November 2022, for studies analyzing CCA rate in patients taking metformin. Twenty-nine articles were initially identified, of which four were eligible and included in our systematic review and meta-analysis, from which we estimated the relative risk (RR). The rate of CCA was lower for diabetic patients taking metformin than diabetic patients without metformin intake when comparing two highest quality studies [RR, 0.38; 95% confidence interval (CI), 0.290-0.508; P < 0.001], and three studies with similar inclusion criteria (RR, 0.34; 95% CI, 0.51-0.35; P < 0.001) without significant statistical heterogeneity among them (I2 = 29.83%, P = 0,2326 and I2 = 35.08%; P = 0.2143, respectively). Our study demonstrated a significant impact of metformin in reducing the risk of CCA by nearly 62-66% in diabetic patients taking metformin.
胆管癌（CCA）是第二常见的肝癌。糖尿病是一个众所周知的风险因素；然而，据报道二甲双胍治疗对几种癌症具有保护作用，但关于CCA的数据仍然稀少且参差不齐。我们进行了这项荟萃分析，以研究二甲双胍作为CCA潜在保护因素的作用。在这项系统评价和荟萃分析中，我们检索了从数据库创建之日至2022年11月的PubMed/MEDLINE和EMBASE数据库，以查找分析服用二甲双胍患者的CCA发生率的研究。最初鉴定出29篇文章，其中4篇符合条件并纳入我们的系统评价和荟萃分析，我们据此估计相对风险（RR）。在比较两项质量最高的研究时，服用二甲双胍的糖尿病患者的CCA发生率低于未服用二甲双胍的糖尿病患者[RR，0.38；95%置信区间（CI），0.290 - 0.508；P < 0.001]，以及三项具有相似纳入标准的研究（RR，0.34；95%CI，0.51 - 0.35；P < 0.001），它们之间无显著统计学异质性（I2分别为29.83%，P = 0.2326和I2 = 35.08%；P = 0.2143）。我们的研究表明，二甲双胍对服用二甲双胍的糖尿病患者降低CCA风险有显著影响，降低幅度近62% - 66%。
