Association between Metformin Use and Mortality after Cervical Cancer in Older Women with Diabetes
Association between Metformin Use and Mortality after Cervical Cancer in Older Women with Diabetes
复制标题
DOI：
10.1158/1055-9965.epi-15-1008
复制
发表时间：
2016-03-01
影响因子：
3.8
通讯作者：
Fyles, Anthony W.
中科院分区：
文献类型：
--
作者：
Han, Kathy;Pintilie, Melania;Fyles, Anthony W.
背景：为了检查糖尿病和宫颈癌患者的二甲双胍使用与死亡率之间的关联。方法：使用安大略省健康数据库，对 1997 年至 2010 年间诊断为宫颈癌的 66 岁以上糖尿病女性进行了一项回顾性、基于人群的队列研究。使用 Fine-Gray 回归模型检查二甲双胍暴露与宫颈癌特异性死亡率之间的关联，其中非癌症死亡作为竞争风险，累积二甲双胍使用作为随时间变化的暴露。使用 Cox 回归模型检查其与总体死亡率的关联。结果：在 181 名患有糖尿病和宫颈癌的女性中，有 129 人死亡，其中 61 人死于宫颈癌。存活患者的中位随访时间为 5.8 年（四分位数范围 4.2-9.6 年）。宫颈癌诊断后二甲双胍的累积剂量与宫颈癌特异性死亡率和总体死亡率风险降低独立相关，且呈剂量依赖性[HR 0.79； 95%置信区间（CI），0.63-0.98；心率 0.95；每额外使用 365 克二甲双胍，95% CI 分别为 0.90-0.996]。其他抗糖尿病药物的累积使用与宫颈癌特异性死亡率之间没有显着关联。结论：这项研究表明，宫颈癌诊断后累积使用二甲双胍与老年糖尿病女性较低的宫颈癌特异性死亡率和总体死亡率之间存在关联。
Background: To examine the association between metformin use and mortality in patients with diabetes and cervical cancer.Methods: Using Ontario health databases, a retrospective, population-based cohort study was conducted in women with diabetes >= age 66 years diagnosed with cervical cancer between 1997 and 2010. The association between metformin exposure and cervical cancer-specific mortality was examined using Fine-Gray regression models, with noncancer death as a competing risk and cumulative metformin use as a time-varying exposure. The association with overall mortality was examined using Cox regression models.Results: Among the 181 women with diabetes and cervical cancer, there were 129 deaths, including 61 cervical cancer-specific deaths. The median follow-up was 5.8 years (interquartile range 4.2-9.6 years) for surviving patients. Cumulative dose of metformin after cervical cancer diagnosis was independently associated with a decreased risk of cervical cancer-specific mor-tality and overall mortality in a dose-dependent fashion [HR 0.79; 95% confidence interval (CI), 0.63-0.98; and HR 0.95; 95% CI, 0.90-0.996 per each additional 365 g of metformin use, respectively]. There was no significant association between cumulative use of other antidiabetic drugs and cervical cancer-specific mortality.Conclusion: This study suggests an association between cumulative metformin use after cervical cancer diagnosis and lower cervical cancer-specific and overall mortality among older women with diabetes.