近日,，發(fā)表在Obstet Gynecol 雜志上的一篇有關(guān)卵巢癌結(jié)果的綜述"Relationship of Type II Diabetes and Metformin Use to Ovarian Cancer Progression, Survival, and Chemosensitivity"發(fā)現(xiàn)，糖尿病婦女如果服用二甲雙胍，其生存期會(huì)延長(zhǎng),，對(duì)于無(wú)進(jìn)展生存期，服用二甲雙胍的糖尿病婦女要比根本沒(méi)有糖尿病的婦女還要好,，
Iris L. Romero博士等講到,，他們的研究發(fā)現(xiàn)從流行病學(xué)到臨床研究等方面為二甲雙胍的抗腫瘤作用提供越來(lái)越多的證據(jù)。存在一個(gè)生物學(xué)機(jī)制通過(guò)AMPK（磷酸腺苷活化蛋白激酶）激活和一直胰島素信號(hào),，來(lái)介導(dǎo)二甲雙胍的抗癌作用,。
研究小組查看了341名I~IV期卵巢上皮癌（n=273）、輸卵管癌（n=34）和腹膜癌（n=34）患者的數(shù)據(jù),，時(shí)間是1992~2010年,。隊(duì)列中包含16名使用二甲雙胍的糖尿病患者，28名沒(méi)有使用,。
不管是否患有糖尿病,，這些婦女接受相同的方法治療卵巢癌,。各組間手術(shù)后小于1cm的殘余腫瘤行細(xì)胞減滅術(shù)比例，使用的化療類型,，化療周期相似,。幾乎所有的婦女（95%）都接受基于鉑類和紫衫類為基礎(chǔ)的化療，最常用的是卡鉑和紫杉醇,。
該研究報(bào)告認(rèn)為,，使用二甲雙胍的糖尿病患者5年無(wú)進(jìn)展生存率為51%,，沒(méi)使用二甲雙胍的糖尿病病人為8%,，非糖尿病患者為23%（p=0.03）。使用二甲雙胍的5年總體存活率為63%,，未使用二甲雙胍的是23%,，非糖尿病組為37%（p=0.03）?？刂屏?ldquo;標(biāo)準(zhǔn)臨床病理參數(shù)”后,，二甲雙胍的使用與無(wú)進(jìn)展生存率顯著相關(guān)，但是和總體生存率無(wú)相關(guān)性,。
調(diào)整了混雜因素后的生存分析中,，比較使用vs未使用二甲雙胍的糖尿病患者，前者的疾病復(fù)發(fā)風(fēng)險(xiǎn)顯著降低（HR,，0.38）,。二甲雙胍組死亡風(fēng)險(xiǎn)也降低（HR，0.43）,，但差異未達(dá)到統(tǒng)計(jì)學(xué)差異,。與非糖尿病組相比，使用二甲雙胍組的疾病復(fù)發(fā)和死亡率也降低,，但是無(wú)統(tǒng)計(jì)學(xué)差異,。沒(méi)有使用二甲雙胍的糖尿病患者相比無(wú)糖尿病患者，癌癥復(fù)發(fā)風(fēng)險(xiǎn)（HR,，1.42）和死于疾病的風(fēng)險(xiǎn)（HR,，1.33）要升高。
研究者注意到,，其他研究也表明二甲雙胍在多種癌癥中都具有抗腫瘤作用,，包括乳腺癌、前列腺癌,、結(jié)腸癌和卵巢癌,。臨床和實(shí)驗(yàn)室研究也表明，二甲雙胍可以提高病人對(duì)化療的反應(yīng),。目前的研究來(lái)看,，二甲雙胍使用者對(duì)化療的反應(yīng)最好,。
但是本研究是回顧性研究，應(yīng)該考慮到結(jié)果是假設(shè)產(chǎn)生的,，推廣到臨床實(shí)踐還有些困難,。（生物谷Bioon.com）
doi:10.1097/AOG.0b013e3182393ab3
PMC:
PMID:
Relationship of Type II Diabetes and Metformin Use to Ovarian Cancer Progression, Survival, and Chemosensitivity
Romero, Iris L. MD, MS; McCormick, Anna MD, DO; McEwen, Kelsey A. BS; Park, SeoYoung PhD; Karrison, Theodore PhD; Yamada, S. Diane MD; Pannain, Silvana MD; Lengyel, Ernst MD, PhD
OBJECTIVE: To estimate whether metformin use by ovarian cancer patients with type II diabetes was associated with improved survival.
METHODS: We reviewed the effect of diabetes and diabetes medications on ovarian cancer treatment and outcomes in a single-institution retrospective cohort. Inclusion criteria were International Federation of Gynecology and Obstetrics stage I–IV epithelial ovarian, fallopian, or peritoneal cancer. Exclusion criteria were noninvasive pathology or nonepithelial malignancies. The primary exposures analyzed were history of type II diabetes and diabetes medications. The primary outcomes were progression-free and overall ovarian cancer survival.
RESULTS: Of the 341 ovarian cancer patients included in the study, 297 did not have diabetes, 28 were type II diabetic patients who did not use metformin, and 16 were type II diabetic patients who used metformin. The progression-free survival at 5 years was 51% for diabetic patients who used metformin compared with 23% for the nondiabetic patients and 8% for the diabetic patients who did not use metformin (P=.03). The overall survival at 5 years was 63%, 37%, and 23% for the diabetic patients who used metformin, the nondiabetic patients, and the diabetic patients who did not use metformin, respectively (P=.03). The patients with diabetes received the same treatment for ovarian cancer as the patients without diabetes. The association of metformin use and increased progression-free survival, but not overall survival, remained significant after controlling for standard clinicopathologic parameters.
CONCLUSION: In this ovarian cancer cohort, the patients with type II diabetes who used metformin had longer progression-free survival, despite receiving similar treatment for ovarian cancer.
