OBJECTIVE: To systematically analyze and summarize evidence related to the diagnostic and prognostic value of T2DM and metformin for predicting the insurgence and post-treatment outcomes of pNET.
METHODS: A systematic review of the published literature was undertaken, focusing on the role of T2DM and metformin in insurgence and prognosis of pNET, measured through outcomes of tumor-free survival (TFS), overall survival and progression-free survival.
RESULTS: A total of 13 studies (5674 patients) were included in this review. Analysis of 809 pNET cases from five retrospective studies (low study heterogeneity with I² = 0%) confirms the correlation between T2DM and insurgence of pNET (OR = 2.13, 95%CI = 1.56-4.55; P < 0.001). The pooled data from 1174 pNET patients showed the correlation between T2DM and post-treatment TFS in pNET patients (hazard ratio = 1.84, 95%CI = 0.78-2.90; P < 0.001). The study heterogeneity was intermediate, with I² = 51%. A few studies limited the possibility of performing pooled analysis in the setting of metformin; therefore, results were heterogeneous, with no statistical relevance to the use of this drug in the diagnosis and prognosis of pNET.
CONCLUSIONS: T2DM represents a risk factor for the insurgence of pNET and is a significant predictor of poor post-treatment TFS of pNET patients. Unfortunately, a few studies with heterogeneous results limited the possibility of exploring the effect of metformin in the diagnosis and prognosis of pNET.
目的:系统分析和总结2型糖尿病和二甲双胍在预测pNET预防和治疗后结局方面的诊断和预后价值。
方法:对已发表的文献进行了系统综述,重点探讨2型糖尿病和二甲双胍在pNET发病和预后中的作用,通过无瘤生存率(TFS)的结果来衡量,总生存期和无进展生存期。
结果:本综述共纳入13项研究(5674例患者)。对来自5项回顾性研究的809例pNET病例进行分析(研究异质性低,I²=0%),证实了T2DM与pNET预防之间的相关性(OR=2.13,95CI=1.56-4.55;P<0.001)。来自1174名pNET患者的汇总数据显示,T2DM与pNET患者治疗后TFS之间存在相关性(风险比=1.84,95CI=0.78-2.90;P<0.001)。研究的异质性是中等程度的,I²=51%。一些研究限制了在二甲双胍的背景下进行汇总分析的可能性;因此,结果是异质的,与该药物在pNET诊断和预后中的应用无统计学相关性。
结论:T2DM是pNET发病的危险因素,也是pNET患者治疗后TFS不良的重要预测因子。不幸的是,一些结果不一致的研究限制了探索二甲双胍在pNET诊断和预后中的作用的可能性。