AIM:To assess whether metformin,which has a chemopreventive effect in chronic liver disease,has any chemotherapeutic effect in hepatocellular carcinoma.METHODS:This was a retrospective study of 701 patients with newly...AIM:To assess whether metformin,which has a chemopreventive effect in chronic liver disease,has any chemotherapeutic effect in hepatocellular carcinoma.METHODS:This was a retrospective study of 701 patients with newly diagnosed hepatocellular carcinoma(HCC)seen between January 2005 and June 2011 at Mayo Clinic,Rochester,Minnesota.This patient cohort was a part of the global HCC BRIDGE study,which is a large longitudinal study of HCC determining the realworld experience of HCC characteristics,management and patient outcomes.We defined significant metformin exposure as continuation of this agent at least 90d beyond diagnosis of HCC,and compared survival of diabetic patients on metformin to diabetic patients not on metformin and non-diabetics.RESULTS:Our cohort was 72.9%male,with a mean±SD age of 62.6±12.3 years.The most common etiologies of liver disease were hepatitis C(34%),alcoholic liver disease(29%),fatty liver disease(15%)and hepatitis B(9%).By univariate analysis,using diabetics not on metformin as the reference group,diabetic patients with HCC on metformin had no survival advantage,with a HR(95%CI)of 1.0(0.8-1.3).Non-diabetic HCC patients also did not appear to have a survival advantage as compared to diabetic HCC patients not on metformin,as demonstrated by a HR(95%CI)of1.1(0.7-1.7).Diabetics on metformin beyond 90 d after HCC diagnosis had a longer median survival at 34.2 mo,as compared to 25.5 mo among diabetic patients who were not on metformin or had discontinued metformin within 90 d after HCC diagnosis.This finding was likely due to potential survival bias among those who lived long enough to receive metformin.CONCLUSION:Although the literature suggests a chemotherapeutic effect in other malignancies,our study demonstrates no survival benefit to the use of metformin in diabetic patients with HCC.展开更多
This study conducted clinical observation of the treatment of noninsulin dependent dia-betes mellitus (type ) with Semen Persical decoction for purgation with addition (SPDPA) in compari-son with a control group treat...This study conducted clinical observation of the treatment of noninsulin dependent dia-betes mellitus (type ) with Semen Persical decoction for purgation with addition (SPDPA) in compari-son with a control group treated with glyburide. The results of the clinical observations show the total effective rate of SPDPA on 106 cases was 79%. which was equivalent to levels in the control group, butSPDPA was more effective in relieving symptoms. The animal experimental study showed SPDPA couldreduce tasting blood sugar in diabetic patients and rats. Its mechanism may be due to improved secretionof insulin, inhibited excretion by the endocrine cell, increased endocrine pellet inhibition ot insular cellsand improved composition of hepatic glycogen. In traditional Chinese medical theory, the mechanism oftherapeutic action of SPDPA in diabetes mellftus is based on synergistic regulation benefiting the vital en-ergy and nourishing Yin, the activation of blood circulation to dissipate blood stasis and the loosening ofthe bowel to relieve constipation.展开更多
基金Supported by National Institutes of Health,No.NCI CA165076Mayo Clinic Center for Cell Signaling in Gastroenterology,No.NIDDK P30DK084567+1 种基金Mayo Clinic Cancer Center,No.NCI CA15083Mayo Clinic Center for Clinical and Translational Science,No.NCATS UL1 TR000135
文摘AIM:To assess whether metformin,which has a chemopreventive effect in chronic liver disease,has any chemotherapeutic effect in hepatocellular carcinoma.METHODS:This was a retrospective study of 701 patients with newly diagnosed hepatocellular carcinoma(HCC)seen between January 2005 and June 2011 at Mayo Clinic,Rochester,Minnesota.This patient cohort was a part of the global HCC BRIDGE study,which is a large longitudinal study of HCC determining the realworld experience of HCC characteristics,management and patient outcomes.We defined significant metformin exposure as continuation of this agent at least 90d beyond diagnosis of HCC,and compared survival of diabetic patients on metformin to diabetic patients not on metformin and non-diabetics.RESULTS:Our cohort was 72.9%male,with a mean±SD age of 62.6±12.3 years.The most common etiologies of liver disease were hepatitis C(34%),alcoholic liver disease(29%),fatty liver disease(15%)and hepatitis B(9%).By univariate analysis,using diabetics not on metformin as the reference group,diabetic patients with HCC on metformin had no survival advantage,with a HR(95%CI)of 1.0(0.8-1.3).Non-diabetic HCC patients also did not appear to have a survival advantage as compared to diabetic HCC patients not on metformin,as demonstrated by a HR(95%CI)of1.1(0.7-1.7).Diabetics on metformin beyond 90 d after HCC diagnosis had a longer median survival at 34.2 mo,as compared to 25.5 mo among diabetic patients who were not on metformin or had discontinued metformin within 90 d after HCC diagnosis.This finding was likely due to potential survival bias among those who lived long enough to receive metformin.CONCLUSION:Although the literature suggests a chemotherapeutic effect in other malignancies,our study demonstrates no survival benefit to the use of metformin in diabetic patients with HCC.
文摘This study conducted clinical observation of the treatment of noninsulin dependent dia-betes mellitus (type ) with Semen Persical decoction for purgation with addition (SPDPA) in compari-son with a control group treated with glyburide. The results of the clinical observations show the total effective rate of SPDPA on 106 cases was 79%. which was equivalent to levels in the control group, butSPDPA was more effective in relieving symptoms. The animal experimental study showed SPDPA couldreduce tasting blood sugar in diabetic patients and rats. Its mechanism may be due to improved secretionof insulin, inhibited excretion by the endocrine cell, increased endocrine pellet inhibition ot insular cellsand improved composition of hepatic glycogen. In traditional Chinese medical theory, the mechanism oftherapeutic action of SPDPA in diabetes mellftus is based on synergistic regulation benefiting the vital en-ergy and nourishing Yin, the activation of blood circulation to dissipate blood stasis and the loosening ofthe bowel to relieve constipation.
