cancer risk in diabetic patients treated with metformin a systematic review and meta-analysis癌症风险与二甲双胍治疗糖尿病患者的系统回顾和荟萃分析.pdfVIP

Cancer Risk in Diabetic Patients Treated with Metformin: A Systematic Review and Meta-analysis Hiroshi Noto1,2*, Atsushi Goto1,2, Tetsuro Tsujimoto1,2, Mitsuhiko Noda1,2 1 Department of Diabetes and Metabolic Medicine, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan, 2 Department of Diabetes Research, Diabetes Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan Abstract Background: A growing body of evidence has suggested that metformin potentially reduces the risk of cancer. Our objective was to enhance the precision of estimates of the effect of metformin on the risk of any-site and site-specific cancers in patients with diabetes. Methods/Principal Findings: We performed a search of MEDLINE, EMBASE, ISI Web of Science, Cochrane Library, and ClinicalT for pertinent articles published as of October 12, 2011, and included them in a systematic review and meta-analysis. We calculated pooled risk ratios (RRs) for overall cancer mortality and cancer incidence. Of the 21,195 diabetic patients reported in 6 studies (4 cohort studies, 2 RCTs), 991 (4.5%) cases of death from cancer were reported. A total of 11,117 (5.3%) cases of incident cancer at any site were reported among 210,892 patients in 10 studies (2 RCTs, 6 cohort studies, 2 case-control studies). The risks of cancer among metformin users were significantly lower than those among non- metformin users: the pooled RRs (95% confidence interval) were 0.66 (0.49–0.88) for cancer mortality, 0.67 (0.53–0.85) for all- cancer incidence, 0.68 (0.53–0.88) for colorectal cancer (n = 6), 0.20 (0.07–0.59) for hepatocellular cancer (n = 4), 0.67 (0.45– 0.99) for lung cancer (n = 3). Conclusion/Significance: The use of metformin in diabetic patients was associated with significantly lower risks of can