Metformin for primary colorectal cancer prevention in patients with diabetes: a case-control study in a US population.
Metformin for primary colorectal cancer prevention in patients with diabetes: a case-control study in a US population.
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DOI：
10.1002/cncr.29165
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发表时间：
2015-04-01
期刊：
影响因子：
6.2
通讯作者：
Polite BN
中科院分区：
文献类型：
--
作者：
Sehdev A;Shih YC;Vekhter B;Bissonnette MB;Olopade OI;Polite BN
来自观察性研究的新证据表明，二甲双胍可能有益于结直肠癌（CRC）的一级预防。然而，这些研究均未在美国人群中进行。由于环境因素（如西方饮食和肥胖）与结直肠癌的病因有关，我们进行了一项大型病例对照研究，以评估二甲双胍对美国人群结直肠癌发病率的影响。MarketScan®数据库用于识别患有CRC的糖尿病患者。病例定义为具有CRC的偶发诊断。每个病例最多选择两名年龄、性别和地理区域相匹配的对照。在索引日期之前的12个月内，通过处方跟踪评估了二甲双胍暴露。条件logistic回归用于校正多种潜在混杂因素，并计算校正优势比（AOR）。对照组和病例组参与者的平均年龄分别为55岁和57岁（p=1.0）。每组中60%的研究参与者是男性，40%是女性。在多变量模型中，任何二甲双胍的使用与CRC几率降低15%相关（AOR，0.85，95%置信区间（CI），0.76-0.95，p<0.007）。调整医疗保健利用后，二甲双胍的有益作用降低至12%（AOR，0.88，95% CI，0.77-1.00，p=0.05）。剂量反应分析显示与二甲双胍剂量、持续时间或总暴露量无显著相关性。在美国人群中，使用二甲双胍与糖尿病患者发生CRC的风险降低相关。
Emerging evidence from observational studies suggests that metformin may be beneficial in the primary prevention of colorectal cancer (CRC). However, none of these were conducted in a US population. Since environmental factors, such as Western diet and obesity, are implicated in the causation of CRC, we conducted a large case control study to assess the effects of metformin on CRC incidence in a US population. MarketScan® databases were used to identify diabetic patients with CRC. A case was defined as having an incident diagnosis of CRC. Up to two controls matched for age, sex and geographical region, were selected for each case. Metformin exposure was assessed by prescription tracking in the 12 months period prior to the index date. Conditional logistic regression was used to adjust for multiple potential confounders and to calculate adjusted odds ratios (AOR). The mean age of participants was 55 and 57 years in the control and case group, respectively (p=1.0). Sixty percent of the study participants were males and 40% were females in each group. In the multivariable model, any metformin use was associated with 15% reduced odds of CRC (AOR, 0.85, 95% confidence interval (CI), 0.76–0.95, p<0.007). After adjusting for health-care utilization the beneficial effect of metformin was reduced to 12% (AOR, 0.88, 95% CI, 0.77–1.00, p=0.05). The dose-response analyses showed no significant association with metformin dose, duration or total exposure. Metformin use is associated with reduced risk of developing CRC among diabetic patients in the US population.