二甲双胍对局部晚期直肠癌合并糖尿病的疗效观察

摘要

目的：探讨二甲双胍对局部晚期直肠癌合并糖尿病患者病理学完全缓解（ CR）率和预后的影响。方法：选取1996—2010年孝感市各大医院收治的局部晚期直肠癌患者482例，对其给予放化疗和直肠全系膜切除术治疗，平均辐射剂量为50.4 Gy （19.8～63 Gy），化疗药为氟尿嘧啶或卡培他滨。患者被分为非糖尿病组（422例）、糖尿病未服用二甲双胍组（40例）和糖尿病服用二甲双胍组（20例），对比分析3组患者的病理学CR率。结果：临床肿瘤分级、淋巴结分级、肿瘤距肛缘或圆周范围、预处理癌胚抗原水平、病理分化方面比较，3组间差异无统计学意义（P＜0.05）。病理学CR率方面，非糖尿病组患者为16.6％（70／422），糖尿病未服用二甲双胍组患者为7.5％（3／40），而糖尿病服用二甲双胍组患者为35.0％（7／20）。糖尿病服用二甲双胍组患者与非糖尿病组患者、糖尿病未服用二甲双胍组患者相比，具有较高的CR率（ P＝0.03、P＝0.007）；服用二甲双胍与病理学CR率单因素和多因素显著有关（ P＝0.05、P＝0.01）；此外，与其他糖尿病患者相比，服用二甲双胍患者的无病和总生存期显著增加（ P＝0.013、P＝0.008）。结论：二甲双胍的使用，显著提高了局部晚期直肠癌合并糖尿病患者的病理学CR率和生存率。%OBJECTIVE:To investigate the complete response and prognosis of the patients with locally advanced rectal cancer complicating diabetes mellitus treated with metfomin.METHODS: A total of 482 patients with locally advanced rectal cancer from the primary hospitals in Xiaogan during 1996-2010 period were assigned to receive chemoradiotherapy[with average radiation dose of 50.9 Gy(19.8-63 Gy) and fluorouracil or capecitabine was used as chemotherapy drug] and total mesorectal excision.The patients were divided into non-diabetic group (422 cases), metformin-free diabetic group(40 cases) and metformin-treated diabetic group(20 cases).The pathological complete resonse(CR) rates in the three groups were analyzed contrastively.RESULTS: No significant differences were noted across the three groups in clinical tumor grade, lymph node grade, distance between tumor and the anal margin or circumferential extent of tumor, pretreated carcinoembryonic antigen level and pathologic differentiation (P<0.05).The pathological CR rate in non-diabetic group was 16.6%( 70/422 ) , as compared with 7.5%( 3/40 ) in metformin-free diabetic group and 35.0%(7/20) in metformin-treated diabetic group.The CR rate in metformin-treated diabetic group was higher than in non-diabetic group or than in metformin-free diabetic group(P=0.03, P=0.007);metformin oral administraiton was significantly related to pathologic CR rate (both univariate and multivariate)(P=0.05;P=0.01);in addition, compared with other diabetics, those taking metformin had significantly increased disease-free time and overall survival(P=0.013;P=0.008).CONCLUSIONS: Metformin use is associated with significantly increased CR rate and survival rate in patients with locally advanced rectal cancer complicating diabetes mellitus.