Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA.
Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Laryngoscope. 2023 Sep;133(9):2066-2072. doi: 10.1002/lary.30601. Epub 2023 Feb 6.
To systematically review and evaluate metformin's potential impact on vestibular schwannoma (VS) growth.
PubMed, Cochrane Library, and Embase.
A retrospective cohort study was performed on sporadic VS patients undergoing initial observation who had at least two magnetic resonance imaging studies. Patients were stratified by metformin use during the observation period. Primary endpoint was VS growth, defined as at least a 2 mm increase in diameter. Survival free of tumor growth was evaluated between groups. Systematic review and meta-analysis were performed to produce a pooled odds ratio [OR]. Study heterogeneity was assessed and post-hoc power analysis was performed.
A total of 123 patients were included, of which 17% were taking metformin. Median patient age was 56.6 years (range, 25.1-84.5). There were no statistically significant differences between the groups. Survival analysis did not demonstrate a statistically significant difference in time to VS growth between groups (hazard ratio = 0.61, 95% confidence interval [CI] = 0.29-1.29). Furthermore, logistic regression analysis did not demonstrate a statistically significant difference between groups in the odds of VS growth (OR = 0.46, 95% CI = 0.17-1.27). Systematic review identified 3 studies. Meta-analysis suggested that metformin reduces the odds of developing VS growth (pooled OR = 0.45, 95% CI = 0.29-0.71). Studies demonstrated low between-study heterogeneity. Power analysis demonstrated a sample size of 220 patients with equal randomization would be required to prospectively identify a true difference with 80% power.
Metformin use may reduce the odds of VS growth. A randomized trial would be ideal to identify an unbiased estimate of metformin's effect on VS growth. Laryngoscope, 133:2066-2072, 2023.
系统回顾和评估二甲双胍对前庭神经鞘瘤（VS）生长的潜在影响。
PubMed、Cochrane 图书馆和 Embase。
对接受初始观察的散发性 VS 患者进行回顾性队列研究，这些患者至少进行了两次磁共振成像研究。根据观察期间是否使用二甲双胍，将患者分为两组。主要终点是 VS 生长，定义为直径至少增加 2mm。评估两组之间无肿瘤生长的生存情况。进行系统回顾和荟萃分析以产生合并优势比[OR]。评估研究异质性并进行事后功效分析。
共纳入 123 例患者，其中 17%服用二甲双胍。中位患者年龄为 56.6 岁（范围 25.1-84.5）。两组间无统计学差异。生存分析显示两组间 VS 生长时间无统计学差异（风险比=0.61，95%置信区间[CI] 0.29-1.29）。此外，逻辑回归分析显示两组间 VS 生长的可能性无统计学差异（OR=0.46，95%CI 0.17-1.27）。系统回顾确定了 3 项研究。荟萃分析表明，二甲双胍降低了 VS 生长的可能性（合并 OR=0.45，95%CI 0.29-0.71）。研究显示异质性低。功效分析表明，需要 220 例具有同等随机分组的患者进行前瞻性研究，以 80%的功效确定二甲双胍对 VS 生长的真实影响。
二甲双胍的使用可能降低 VS 生长的可能性。理想情况下，需要进行随机试验来确定二甲双胍对 VS 生长影响的无偏估计。喉科学，133：2066-2072，2023。
