国际肿瘤学杂志

国际肿瘤学杂志 ›› 2020, Vol. 47 ›› Issue (7): 404-408.doi: 10.3760/cma.j.cn371439-20191125-00045

• 论著 • 上一篇    下一篇

二甲双胍对合并2型糖尿病的Ⅰ型子宫内膜癌患者预后的影响

王雪1, 纪国欣1, 纪超1, 杨兴升2()   

  1. 1青岛市立医院产科 266000
    2山东大学齐鲁医院妇产科,济南 250012
  • 收稿日期:2019-11-25 修回日期:2020-05-15 出版日期:2020-07-08 发布日期:2020-08-18
  • 通讯作者: 杨兴升 E-mail:xingshengyang@sdu.edu.cn

Effects of metformin on prognosis of type Ⅰ endometrial carcinoma patients complicated with type 2 diabetes mellitus

Wang Xue1, Ji Guoxin1, Ji Chao1, Yang Xingsheng2()   

  1. 1Department of Obstetrics, Qingdao Municipal Hospital, Qingdao 266000, China
    2Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan 250012, China
  • Received:2019-11-25 Revised:2020-05-15 Online:2020-07-08 Published:2020-08-18
  • Contact: Yang Xingsheng E-mail:xingshengyang@sdu.edu.cn

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摘要：

目的 研究服用二甲双胍对合并2型糖尿病(T2DM)的Ⅰ型子宫内膜癌(EC)患者预后的影响。方法 回顾性分析2010年1月至2014年12月之间就诊于山东大学齐鲁医院的45例合并T2DM的Ⅰ型EC患者(糖尿病组)与同期147例不合并糖尿病的Ⅰ型EC患者(非糖尿病组)的临床资料,合并T2DM的Ⅰ型EC患者中二甲双胍组23例(口服二甲双胍控制血糖在正常范围),非二甲双胍组22例(口服其他类降糖药或应用胰岛素控制血糖在正常范围)。比较糖尿病组和非糖尿病组患者的临床病理特征,并分析二甲双胍对合并T2DM的Ⅰ型EC患者预后的影响。结果 与非糖尿病组相比,糖尿病组Ⅰ型EC患者的发病年龄大(t=4.331,P<0.001)、更易合并高血压(χ2=19.252,P<0.001)、手术-病理分期晚(χ2=4.588,P=0.032)、组织学分级高(χ2=6.069,P=0.048)、肌层浸润深(χ2=7.743,P=0.005)、淋巴结转移发生率高(χ2=4.885,P=0.027)。二甲双胍组患者的中位无进展生存期(PFS)(47.0个月 vs. 38.0个月)及中位总生存期(OS)(52.0个月 vs. 41.0个月)较非二甲双胍组明显延长,差异均具有统计学意义(χ2=10.899,P=0.001;χ2=10.090,P=0.001)。二甲双胍组与非糖尿病组的中位PFS(47.0个月 vs. 46.0个月)及中位OS(52.0个月 vs. 46.0个月)差异均无统计学意义(χ2=0.791,P=0.374;χ2=0.836,P=0.360)。Cox多因素分析显示,发病年龄大(OR=2.128,95%CI为1.361~3.328,P=0.001;OR=4.502,95%CI为1.696~11.954,P=0.003)、手术-病理分期晚(OR=2.231,95%CI为1.437~3.462,P=0.001;OR=4.005,95%CI为1.480~10.836,P=0.006)、组织学分级高(P=0.001;P=0.017;G2/G1:OR=5.660,95%CI为3.424~9.357,P=0.001;OR=5.763,95%CI为1.666~19.938,P=0.006)、肌层浸润深(OR=1.531,95%CI为1.049~2.235,P=0.027;OR=3.759,95%CI为1.890~7.476,P=0.001)、淋巴结转移阳性(OR=11.277,95%CI为2.774~45.838,P=0.001;OR=8.451,95%CI为1.138~62.767,P=0.037)、合并T2DM(OR=1.897,95%CI为1.096~3.281,P=0.008;OR=1.813,95%CI为1.043~3.151,P=0.012)为Ⅰ型EC患者PFS和OS的危险因素,服用二甲双胍为合并T2DM的Ⅰ型EC患者PFS(OR=0.412,95%CI为0.207~0.818,P=0.002)及OS(OR=0.455,95%CI为0.228~0.905,P=0.008)的保护因素。结论 合并T2DM是Ⅰ型EC患者的不良预后因素,服用二甲双胍能明显改善合并T2DM的Ⅰ型EC患者的PFS及OS,改善患者预后。

关键词: 糖尿病, 2型, 子宫内膜肿瘤, 二甲双胍, 预后

Abstract:

Objective To explore the effects of metformin on the prognosis of type Ⅰ endometrial carcinoma (EC) patients complicated with type 2 diabetes mellitus (T2DM). Methods The clinical data of 45 type Ⅰ EC patients complicated with T2DM (T2DM group) and 147 type Ⅰ EC patients without diabetes mellitus (non-diabetes group) admitted to Qilu Hospital of Shandong University from January 2010 to December 2014 were retrospectively analyzed. The type Ⅰ EC patients with T2DM were divided into two groups, metformin group (n=23, taking metformin to control blood glucose in normal range) and non-metformin group (n=22, taking other hypoglycemic drugs or using insulin to control blood glucose in normal range). The clinicopathological characteristics of T2DM group and non-diabetes group were compared, and the effects of metformin on the prognosis of type Ⅰ EC patients with T2DM were analyzed. Results Compared with non-diabetes group, the type Ⅰ EC patients in T2DM group have the older onset age (t=4.331, P<0.001), more complicated with hypertension (χ2=19.252, P<0.001), later surgical pathological stage (χ2=4.588, P=0.032), higher histological grade (χ2=6.069, P=0.048), deeper myometrial infiltration (χ2=7.743, P=0.005) and higher incidence of lymph node metastasis (χ2=4.885, P=0.027). The median progression-free survival (PFS) (47.0 months vs. 38.0 months) and median overall survival (OS) (52.0 months vs. 41.0 months) in metformin group were significantly longer than those in non-metformin group (χ2=10.899, P=0.001; χ2=10.090, P=0.001). There was no significant difference in median PFS (47.0 months vs. 46.0 months) and median OS (52.0 months vs. 46.0 months) between metformin group and non-diabetes group (χ2=0.791, P=0.374; χ2=0.836, P=0.360). Cox multivariate analysis showed that the risk factors of PFS and OS in type ⅠEC patients were old onset age(OR=2.128, 95%CI: 1.361-3.328, P=0.001; OR=4.502, 95%CI: 1.696-11.954, P=0.003), late surgical pathological stage(OR=2.231, 95%CI: 1.437-3.462, P=0.001; OR=4.005, 95%CI: 1.480-10.836, P=0.006), high histological grade(P=0.001; P=0.017; G2 vs.G1: OR=5.660, 95%CI: 3.424-9.357, P=0.001; OR=5.763, 95%CI: 1.666-19.938, P=0.006), deep myometrial invasion(OR=1.531, 95%CI: 1.049-2.235, P=0.027; OR=3.759, 95%CI: 1.890-7.476, P=0.001), positive lymph node metastasis (OR=11.277, 95%CI: 2.774-45.838, P=0.001; OR=8.451, 95%CI: 1.138-62.767, P=0.037)and T2DM (OR=1.897, 95%CI: 1.096-3.281, P=0.008; OR=1.813, 95%CI: 1.043-3.151, P=0.012). Metformin was the protective factor of PFS (OR=0.412, 95%CI: 0.207-0.818, P=0.002) and OS (OR=0.455, 95%CI: 0.228-0.905, P=0.008) in type Ⅰ EC patients with T2DM. Conclusion Complication with T2DM is the negative factor on the prognosis of type Ⅰ EC patients. Intake of metformin can significantly improve the PFS and OS of type Ⅰ EC patients complicated with T2DM and improve the prognosis.

Key words: Diabetes mellitus, type 2, Endometrial neoplasms, Metformin, Prognosis