背景：最近的流行病学研究表明，抗糖尿病药物（ADMs）可以降低2型糖尿病患者的癌症风险和癌症死亡率。然而,关于其对子宫内膜癌（EC）的影响的数据尚不清楚。在这篇系统综述和荟萃分析中，我们评估了二甲双胍之间的关联，磺酰脲类(SU)，胰岛素，以及糖尿病（DM）患者发生EC的风险。
方法：从PubMed和EMBASE数据库中确定了截至2017年10月的研究。选择报告相对风险或提供评估数据的观察性研究。使用随机效应模型估计95%CI的汇总OR估计值。
结果：6项研究（2个回顾性队列和4个病例对照试验）报道了510,344例DM患者中的4,739例EC。观察性研究的荟萃分析显示二甲双胍之间没有显着关联（n=6项研究；未调整OR1.15；95％CI0.70-1.88；p=0.59），SUs（未调整OR1.11，95%CI0.94-1.32，p=0.23），或胰岛素（n=3项研究；未调整OR1.15；95％CI0.93-1.40；p=0.19）的使用和发生EC的风险。然而,当我们进行异质性和敏感性分析时，与不使用二甲双胍相比,使用二甲双胍与子宫内膜EC发生率增加相关(未校正OR1.29;95%CI1.16~1.44;p<0.01).
结论：我们的数据表明二甲双胍，SUs,胰岛素对EC的风险没有显著影响.需要进一步调查。
BACKGROUND: Recent epidemiological studies suggest that antidiabetic medications (ADMs) may reduce the risks of cancer and cancer mortality among patients with type 2 diabetes. However, data on its effect on endometrial cancer (EC) are unclear. In this systematic review and meta-analysis, we evaluated the association between metformin, sulfonylureas (SUs), insulin, and the risk of EC in patients with diabetes mellitus (DM).
METHODS: Studies were identified from PubMed and EMBASE database through October 2017. Observational studies reporting relative risks OR or provided data for their estimation were selected. Summary OR estimates with 95% CIs were estimated using the random-effects model.
RESULTS: Six studies (2 retrospective cohorts and 4 case-control trials) reported 4,739 cases of EC in 510,344 patients with DM. Meta-analysis of observational studies showed no significant association between metformin (n = 6 studies; unadjusted OR 1.15; 95% CI 0.70-1.88; p = 0.59), SUs (unadjusted OR 1.11, 95% CI 0.94-1.32, p = 0.23), or insulin (n = 3 studies; unadjusted OR 1.15; 95% CI 0.93-1.40; p = 0.19) use and risk of developing EC. However, when we do heterogeneity and sensitivity analysis, the use of metformin was associated with an increased incidence of endometrial EC compared to no metformin use (unadjusted OR 1.29; 95% CI 1.16-1.44; p < 0.01).
CONCLUSIONS: Our data indicate that metformin, SUs, and insulin did not meaningfully affect the risk of EC. Further investigation is warranted.
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