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2017 ; 8
(16
): 26448-26459
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Prognostic role of metformin intake in diabetic patients with colorectal cancer:
An updated qualitative evidence of cohort studies
#MMPMID28103573
Du L
; Wang M
; Kang Y
; Li B
; Guo M
; Cheng Z
; Bi C
Oncotarget
2017[Apr]; 8
(16
): 26448-26459
PMID28103573
show ga
Several observational studies have shown that metformin can modify the risk and
survival of colorectal cancer (CRC) in patients with diabetes mellitus, although
the magnitude of this relationship has not been determined. We conducted an
updated systematic review and meta-analysis to analyze the association between
metformin and CRC mortality and searched relevant databases up to July 2016. The
primary outcome was overall survival (OS). Secondary outcomes were
cancer-specific survival (CS) and disease-free survival (DFS). Summary hazard
ratios (HRs) were calculated using a random-effects model. Seventeen studies
enrolling 269,417 participants were eligible for inclusion. Comparing with
non-metformin users in diabetic CRC patients, the summary HRs for OS in metformin
users were 0.69 (95% CI, 0.61-0.77). Subgroup analyses stratified by the study
characteristics and sensitivity analysis by the trim-and-fill method (adjusted HR
0.77, 95% CI, 0.67-0.87) confirmed the robustness of the results. However,
significant OS benefit was noted in patients with stage II and III disease. Five
studies reported the CRC prognosis for CS and three for DFS; metformin intake was
significantly associated with patient CS (HR 0.75, 95% CI, 0.59-0.94), but not
DFS (HR 0.38, 95% CI, 0.13-1.17). Our findings suggest that metformin intake is
associated with improved survival outcomes in terms of OS and CS in CRC patients
with diabetes, particular for OS in stage II and stage III patients. Further
studies should be conducted to determine CRC survival between metformin use and
patient specific clinical and molecular profiles.