Department of Pharmacy Practice, Philadelphia College of Osteopathic Medicine, Suwanee, GA, USA.
Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, USA.
Cardiovasc Intervent Radiol. 2023 Jul;46(7):870-879. doi: 10.1007/s00270-023-03467-1. Epub 2023 May 22.
Examine the association of metformin use and overall survival (OS) in patients with HCC undergoing image-guided liver-directed therapy (LDT): ablation, transarterial chemoembolization (TACE), or Yttrium-90 radioembolization (Y90 RE).
Using National Cancer Institute Surveillance, Epidemiology, and End Results registry and Medicare claims databases between 2007 and 2016, we identified patients ≥ 66 years who underwent LDT within 30 days of HCC diagnosis. Patients with liver transplant, surgical resection, and other malignancies were excluded. Metformin use was identified by at least two prescription claims within 6 months before LDT. OS was measured by time between first LDT and death or last Medicare observation. Comparisons were performed between both all and diabetic patients on and not on metformin.
Of 2746 Medicare beneficiaries with HCC undergoing LDT, 1315 (47.9%) had diabetes or diabetes-related complications. Among all and diabetic patients, 433(15.8%) and 402 (30.6%) were on metformin respectively. Median OS was greater for patients on metformin (19.6 months, 95% CI 17.1-23.0) vs those not (16.0 months, 15.0-16.9; p = 0.0238). Patients on metformin had lower risk of death undergoing ablation (HR 0.70; 0.51-0.95; p = 0.0239) and TACE (HR 0.76, 0.66-0.87; p = 0.0001), but not Y90 RE (HR1.22, 0.89-1.69; p = 0.2231). Among diabetics, OS was greater for those on metformin vs those not (HR 0.77, 0.68-0.88; p < 0.0001). Diabetic patients on metformin had longer OS undergoing TACE (HR 0.71, 0.61-0.83; p < 0.0001), but not ablation (HR 0.74, 0.52-1.04; p = 0.0886) or Y90 RE (HR 1.26, 0.87-1.85; p = 0.2217).
Metformin use is associated with improved survival in HCC patients undergoing TACE and ablation.
检查二甲双胍在接受影像引导肝定向治疗（LDT）的 HCC 患者中的使用与总生存期（OS）之间的关联：消融、经动脉化疗栓塞（TACE）或钇-90 放射性栓塞（Y90 RE）。
我们使用国家癌症研究所监测、流行病学和最终结果登记处和 2007 年至 2016 年之间的医疗保险索赔数据库，确定了在 HCC 诊断后 30 天内接受 LDT 的≥66 岁的患者。排除接受肝移植、手术切除和其他恶性肿瘤的患者。二甲双胍的使用是通过 LDT 前 6 个月内至少有两次处方证明来确定的。OS 通过首次 LDT 与死亡或最后一次 Medicare 观察之间的时间来衡量。在所有接受 LDT 的 HCC 患者和接受和未接受二甲双胍治疗的糖尿病患者之间进行了比较。
在接受 LDT 的 2746 名 Medicare 受益人中，有 1315 名（47.9%）患有糖尿病或与糖尿病相关的并发症。在所有接受 LDT 的患者和糖尿病患者中，分别有 433 名（15.8%）和 402 名（30.6%）接受了二甲双胍治疗。接受二甲双胍治疗的患者中位 OS 更长（19.6 个月，95%CI17.1-23.0），而非接受二甲双胍治疗的患者中位 OS 更短（16.0 个月，15.0-16.9；p=0.0238）。接受消融治疗（HR0.70；0.51-0.95；p=0.0239）和 TACE（HR0.76，0.66-0.87；p=0.0001）的患者死亡风险较低，但接受 Y90 RE（HR1.22，0.89-1.69；p=0.2231）的患者死亡风险较低。在糖尿病患者中，接受二甲双胍治疗的患者 OS 更长（HR0.77，0.68-0.88；p<0.0001）。接受 TACE 的糖尿病患者 OS 更长（HR0.71，0.61-0.83；p<0.0001），但接受消融治疗（HR0.74，0.52-1.04；p=0.0886）或 Y90 RE（HR1.26，0.87-1.85；p=0.2217）的患者 OS 更短。
二甲双胍的使用与接受 TACE 和消融治疗的 HCC 患者的生存改善相关。
