Relationship between metformin therapy and risk of colorectal cancer in patients with diabetes mellitus: a meta-analysis
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ORIGINAL ARTICLE
Relationship between metformin therapy and risk of colorectal cancer in patients with diabetes mellitus: a meta-analysis Wen-Tao Yang 1
&
Hao-Jie Yang 1 & Jian-Guo Zhou 1 & Jia-Le Liu 1
Accepted: 14 July 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objective At present, there are many studies on metformin and the risk of colorectal cancer in patients with diabetes, but the conclusions are contradictory. Our aim is to comprehensively collect the published literature and systematically evaluate the relationship between metformin and the risk of colorectal cancer in patients with diabetes. Methods We systematically searched the MEDLINE, EMBASE, and CENTRAL databases up to March 2020. We adopted adjusted estimates and their 95% confidence intervals (CI) to calculate summary effect estimates using either a fixed-effects or a random-effects model. Results A total of 17 articles were included in this study, with a total of 1,092,074 patients with diabetes. Meta-analysis of observational studies showed that metformin treatment could significantly reduce the incidence of colorectal cancer in diabetic patients (adjusted RR = 0.884, 95%CI = 0.829–0.943), and there was heterogeneity between studies (p = 0.013, I2 = 47.9%). Subgroup analysis showed that metformin treatment was significantly associated with a significantly reduced risk of colorectal cancer in diabetics in America and Europe (adjusted RR = 0.852, 95%CI = 0.786–0.924; adjusted RR = 0.900, 95%CI = 0.845– 0.958). Patients with diabetes treated with metformin had a significantly lower risk of colorectal cancer compared with patients who had never been treated with metformin or sulfonamide monotherapy (adjusted RR = 0.863, 95%CI = 0.776–0.960; adjusted RR = 0.911, 95%CI = 0.882–0.941). Conclusions Metformin therapy is associated with a significantly reduced risk of colorectal disease in patients with diabetes, and it is necessary to conduct larger, more standardized clinical studies to verify this conclusion. Keywords Diabetes . Metformin . Incidence of colorectal cancer . Meta-analysis
Introduction According to the statistics of the American Cancer Society (ACS), colorectal cancer is the third most common malignant tumor in the world [1], with a high degree of malignancy and
* Wen-Tao Yang [email protected] Hao-Jie Yang [email protected] Jian-Guo Zhou [email protected] Jia-Le Liu [email protected] 1
Ningxia Medical University (Shuangyi Campus), No. 692 Shengli Street, Yinchuan City, Ningxia Hui Autonomous region, China
poor prognosis, and there is a lack of effective clinical treatment. Therefore, the early prevention of colorectal cancer is very important. Because of its adenoma-adenocarcinoma evolution sequence [2], which takes a long time, it provides the possibility for prevention. Now, the main preventive measure is regular colonoscopy for high-risk groups [3]. Surgical resection of precancerous lesions found in advance to block the development of colorectal cancer, however, because the process of colonoscopy
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