Background: Diabetic patients with breast cancer receiving metformin and neoadjuvant chemotherapy have a higher pathologic complete response rate than do diabetic patients not receiving metformin, but findings on salvage treatment have been inconsistent. We performed a meta-analysis to assess the effect of adding metformin to standard therapy on the prognosis of breast cancer patients with diabetes.
Methods: We searched PubMed, Embase, Web of Science (Thomson Scientific), China Knowledge Resource Integrated Database, VIP journal integration platform, and Chinese BioMedical Literature Database from inception to January 10, 2015, without language restrictions, including references related to metformin, breast cancer, and prognosis. We performed the meta-analysis using a random-effects model, with hazard ratios (HRs) and 95% confidence intervals (95% CIs) as effect measures.
Results: A total of 11 studies consisting of 5,464 breast cancer patients with diabetes were included, comprising 2,760 patients who had received metformin and 2,704 patients who had not. The meta-analysis showed that metformin was associated with better overall survival times (HR: 0.53; 95% CI: 0.39-0.71) and cancer-specific survival times (HR: 0.89; 95% CI: 0.79-1.00). Subgroup analysis revealed that metformin improved the overall survival by 65% after adjusting for hormone receptor expression (HR: 0.35; 95% CI: 0.15-0.84). Taking metformin after the diagnosis of breast cancer was still associated with prolonged overall survival.
Conclusion: The use of metformin in standard cancer therapy might improve both overall and cancer-specific survivals of diabetic patients with breast cancer.
Implications for practice: Diabetic patients with breast cancer receiving metformin and neoadjuvant chemotherapy have a higher pathologic complete response rate than diabetic patients not receiving metformin, but findings on salvage treatment have been inconsistent. The meta-analysis showed that metformin was associated with better overall survival times and cancer-specific survival times. Subgroup analysis revealed that metformin improved the overall survival by 65% after adjusting for hormone receptor expression. Taking metformin after the diagnosis of breast cancer was still associated with prolonged overall survival. The findings of this study highlight the potential usage of metformin in diabetic patients with breast cancer.
摘要
背景. 合并糖尿病的乳腺癌患者中,接受二甲双胍与新辅助化疗者的病理学完全缓解率优于未接受二甲双胍治疗者,但有关挽救性治疗的研究结果并不一致。我们开展了一项 meta 分析,目的是在合并糖尿病的乳腺癌患者中,评估标准治疗基础上添加二甲双胍治疗对预后的影响。
方法. 我们在 PubMed、Embase、Web of Science (汤普森科技)、中国知识资源总库、维普期刊资源整合服务平台和中国生物医学文献数据库中,对起始至 2015 年 1 月 10 日的数据进行了检索。检索对象包括与二甲双胍、乳腺癌和预后相关的参考文献,未设语种限制。我们的 meta 分析使用了随机效应模型,使用风险比 (HR) 和 95%可信区间 (CI) 进行效应测量。
结果. 共纳入 11 项研究,涉及 5 464 例合并糖尿病的乳腺癌患者,包括 2 760 例接受二甲双胍治疗的患者和 2 704 例未接受二甲双胍治疗的患者。Meta 分析显示二甲双胍治疗患者的总生存时间(HR: 0.53, 95%CI: 0.39 ∼ 0.71)和癌症相关生存时间较长 (HR: 0.89, 95%CI: 0.79 ∼ 1.00)。亚组分析显示,校正激素受体表达状态后,二甲双胍治疗使总生存时间延长了65% (HR: 0.35, 95%CI: 0.15 ∼ 0.84)。在诊断为乳腺癌之后才开始二甲双胍治疗仍然与总生存时间延长相关。
结论. 在标准抗癌治疗方案基础上加用二甲双胍,可改善合并糖尿病的乳腺癌患者的总生存及癌症相关生存。The Oncologist 2015;20:1236–1234
对临床实践的提示:合并糖尿病的乳腺癌患者中,接受二甲双胍与新辅助化疗的患者病理学完全缓解率高于未接受二甲双胍治疗的患者,但有关挽救性治疗的研究结果并不一致。本项 meta 分析显示二甲双胍与总生存时间和癌症相关生存时间较长相关。亚组分析显示,校正激素受体表达状态后,二甲双胍使总生存时间延长了 65%。在诊断为乳腺癌之后才开始二甲双胍治疗仍然与总生存时间延长相关。本研究的结果强调了二甲双胍在合并糖尿病的乳腺癌患者中的潜在应用。
Keywords: Breast cancer; Diabetes mellitus; Meta-analysis; Metformin; Survival.
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