背景:2型糖尿病(DM2)和每天连续使用抗糖尿病药物的特点是全球范围内频繁流行,并显示影响恶性疾病的发生和发展。虽然在各种恶性肿瘤中观察到这些影响,关于DM2和抗糖尿病药物在头颈部黑色素瘤(HNM)患者预后中作用的全面数据缺失.
方法:这项基于人群的回顾性队列研究包括382名来自巴伐利亚州东部的HNM患者,这些患者在2010年至2017年期间接受了肿瘤切除至阴性边缘。根据DM2和常规二甲双胍摄入量评估无复发生存期(RFS)。通过单和多变量分析进行统计分析。中位随访时间为5.6年。
结果:在68例患者中诊断出DM2(17.8%),39例(10.2%)常规服用二甲双胍。单变量生存分析显示,与非糖尿病对照组相比,患有DM2的HNM患者的5年RFS受损(p=0.016;64.0%和74.5%,分别)。多变量Cox回归证实了这一效应(HR=1.980,95%CI=1.108-3.538,p=0.021)。详细来说,累积局部复发率对糖尿病HNM患者的RFS产生最深远的负面影响(HR=4.173,95%CI=1.628-10.697,p=0.003).对于二甲双胍的摄入量,在多元统计中观察到对RFS的深远积极影响,在完整队列(HR=0.396,95%CI=0.177~0.884,p=0.024)和糖尿病HNM患者队列(HR=0.352,95%CI=0.135~0.913,p=0.032).
结论:本研究强调DM2是HNM患者的相关共病,损害患者生存。二甲双胍摄入与HNM患者的良好预后相关,为未来的辅助治疗方案提供可能的治疗意义。
Type 2 Diabetes (DM2) and the consecutively daily use of antidiabetic medication are characterized by a frequent prevalence worldwide and were shown to impact the initiation and progression of malignant diseases. While these effects were observed in a variety of malignancies, comprehensive data about the role of DM2 and antidiabetic drugs in the outcome of head and neck melanoma (HNM) patients are missing.
This retrospective population-based cohort study included 382 HNM patients from Eastern Bavaria having received tumor resection to negative margins between 2010 and 2017. Recurrence-free survival (RFS) was evaluated with regard to DM2 and routine metformin intake. Statistical analysis was performed by uni- and multivariate analyses. The median follow-up time was 5.6 years.
DM2 was diagnosed in 68 patients (17.8%), routine metformin intake was found in 39 cases (10.2%). The univariate survival analysis revealed impaired 5-year RFS in HNM patients with DM2 compared to non-diabetic controls (p = 0.016; 64.0% and 74.5%, respectively). The multivariate Cox regression substantiated this effect (HR = 1.980, 95% CI = 1.108-3.538, p = 0.021). In detail, the cumulative locoregional recurrence rate displayed the most far-reaching negative effect on the RFS of diabetic HNM patients (HR = 4.173, 95% CI = 1.628-10.697, p = 0.003). For metformin intake, a profound positive effect on the RFS in multivariate statistics was observed, both in the complete cohort (HR = 0.396, 95% CI = 0.177-0.884, p = 0.024) as well as in the cohort of diabetic HNM patients (HR = 0.352, 95% CI = 0.135-0.913, p = 0.032).
This study emphasizes that DM2 is a relevant comorbid condition in HNM patients, impairing patient survival. Metformin intake was associated with a favorable outcome in HNM patients, providing possible therapeutic implications for future adjuvant treatment regimes.