二甲双胍与2型糖尿病患者膀胱癌发病风险及治疗疗效的Meta分析

Metformin and the risk of bladder cancer in patients with type 2 diabetes mellitus and its treatment efficacy:a Meta-analysis

目的 ：系统评价二甲双胍与2型糖尿病患者膀胱癌发病风险以及治疗疗效之间的关系。方法：计算机检索Pub Med、Embase、Cochrane Library、ISI Web of Science和中国知网等数据库,按照文献纳入标准和排除标准选择关于二甲双胍与2型糖尿病患者膀胱癌发病风险以及治疗疗效之间关系的研究,主要结局指标包含发病率（incidence）、癌症特异性死亡率（cancer-specific mortality,CSM）和无复发生存期（recurrence-free survival,RFS）;以风险比（hazard ratio,HR）为效应量,各效应量以95%可信区间（confidence interval,CI）表示,采用STATA 12.0统计软件进行Meta分析。结果 ：最终纳入8项队列研究,共942 055例患者。Meta分析结果显示,观察组（使用二甲双胍进行降糖的2型糖尿病患者）与对照组[使用其他降糖药物（包括磺脲类、噻唑烷二酮类、胰岛素或者其他药物联合）进行降糖的2型糖尿病患者]相比,采用二甲双胍治疗可使2型糖尿病患者的膀胱癌发病风险降低24%（HR=0.76,95%CI：0.59～0.98,P=0.032）、膀胱癌CSM风险降低22%（HR=0.78,95%CI：0.61～1.00,P=0.049）,但不增加2型糖尿病患者膀胱癌的RFS风险（HR=0.70,95%CI：0.44～1.10,P=0.120）。结论 ：二甲双胍治疗可降低2型糖尿病患者罹患膀胱癌的风险以及膀胱癌CSM。

Objective： To evaluate the association of the metformin therapy with the risk of bladder cancer and treatment efficacy in patients with type 2 diabetes mellitus. Methods： A computer-based online search was performed by using PubMed, Embase, Cochrane Library, iSI Web of Science and China National Knowledge Infrastructure （CNKI） databases. According to the inclusion and exclusion criteria, the literatures about metformin and the risk, and treatment efficacy of bladder cancer in patients with type 2 diabetes mellitus were selected. The primary end points included the incidence, cancer-specific mortality and recurrence- free survival. The outcome measures were hazard ratio （HR） with 95% confidence interval （95% CI） for the association between the metformin and the survival of bladder cancer patients. The Meta- analysis was performed using STATA 12.0 software. Results： A total of eight cohort studies involving 942 055 patients were included in this Meta-analysis. The present analysis showed that metformin therapy reduced the incidence of bladder cancer in patients with type 2 diabetes mellitus by 24% （HR = 0.76, 95% CI： 0.59-0.98, P = 0.032）, and reduced the bladder cancer-specific mortality in patients by 22% （HR = 0.78, 95% CI： 0.61-1.00, P = 0.049）, but didn＇t increase the risk of recurrence survival in type 2 diabetes patients with bladder cancer （HR = 0.70, 95% CI： 0.44-1.10, P = 0.120）, as compared with other hypoglycemic drugs including sulfonylurea, thiazolidine diketone and insulin. Conclusion： Metformin can significantly decrease the incidence of bladder cancer and bladder cancer-specific mortality in patients with type 2 diabetes mellitus.