二甲双胍等因素对合并糖尿病的胰腺癌患者生存影响的回顾性研究

发布时间：2018-04-18 04:21

  本文选题：二甲双胍 + 胰腺癌　； 参考：《浙江大学》2017年硕士论文

【摘要】：背景:在我国,胰腺癌排名癌症死因第6位。流行病学资料显示,胰腺癌的1年总生存率只有24%,5年总生存率仅为5%。目前中晚期胰腺癌仍缺乏有效的治疗手段。胰腺癌患者往往合并糖尿病并且接受降糖治疗。多项基础研究及回顾性研究表明了二甲双胍可降低包括胰腺癌在内的多种肿瘤发病率及改善预后,但缺乏基于人群的大型随机对照试验,还需要进一步的证据来确定临床实践中二甲双胍的使用对胰腺癌患者的生存期是否存在影响。目的:探讨二甲双胍及其他临床特征因素对合并糖尿病的胰腺癌患者生存的影响。方法:回顾性收集2013-08-01至2016-07-31期间浙江大学医学院附属邵逸夫医院住院同时确诊为胰腺癌和糖尿病的87位患者的临床特征,统计分析胰腺癌患者的临床预后因素,如性别、年龄、CA199水平、BMI、吸烟史、饮酒史、肿瘤部位、肿瘤大小、肿瘤治疗方案、糖尿病治疗方案,比较这些临床特征在是否接受二甲双胍治疗上的差异,使用Kaplan-Meier评估及绘制生存曲线,使用单因素及多因素Cox比例风险模型评估各因素对生存期的影响。结果:患者确诊胰腺癌时的平均年龄为64.48±7.33岁(48-82岁),其中男性患者占59.77%。研究对象总体的6个月,1年和3年生存率分别为58.62%,34.48%和6.90%。多因素Cox比例风险回归分析显示胰腺癌早期对生存的危险比为0.211(95%CI:0.109-0.448),未进行化疗对生存的危险比为 1.913(95%CI:1.004-3.643)。在降糖治疗方案中选择使用胰岛素和二甲双胍分别为40.23%和20.69%,是否使用二甲双胍与胰腺癌死亡风险无关(Exp(B):0.837;95%CI:0.242-2.891)。结论:本研究提示合并糖尿病的胰腺癌患者的预后与肿瘤分期、是否进行手术治疗、是否化疗干预相关。二甲双胍的使用不能改善合并糖尿病的胰腺癌患者的预后。其原因可能与研究样本量过少、二甲双胍未达到有效血药浓度及随访时间较短相关,后续可通过扩充样本量或多中心研究,统计二甲双胍使用剂量和时间及延长随访时间等手段来进一步明确二甲双胍的使用对合并糖尿病的胰腺癌患者的预后影响。
[Abstract]:Background: pancreatic cancer is the sixth leading cause of cancer death in China.Epidemiological data showed that the 1-year overall survival rate of pancreatic cancer was only 24%, and the 5-year overall survival rate was only 5%.At present, there is still a lack of effective treatment for advanced pancreatic cancer.Pancreatic cancer patients often have diabetes and receive hypoglycemic treatment.A number of basic and retrospective studies have shown that metformin can reduce the incidence and improve the prognosis of a variety of tumors, including pancreatic cancer, but lacks a population-based large randomized controlled trial.Further evidence is needed to determine whether the use of metformin in clinical practice has an impact on survival in patients with pancreatic cancer.Objective: to investigate the effect of metformin and other clinical characteristics on the survival of pancreatic cancer patients with diabetes mellitus.Methods: the clinical features of 87 patients with pancreatic cancer and diabetes were collected retrospectively from January 2013-08-01 to 2016-07-31. The clinical prognostic factors, such as sex, were statistically analyzed in 87 patients with pancreatic cancer and diabetes mellitus who were hospitalized in run run run Shaw Hospital of Zhejiang University Medical College.Age CA199 levels, smoking history, drinking history, tumor site, tumor size, tumor treatment regimen, diabetes treatment protocol, compared these clinical characteristics in whether to receive metformin treatment or not, using Kaplan-Meier to evaluate and draw survival curve.Univariate and multivariate Cox proportional risk models were used to evaluate the effects of each factor on survival.Results: the mean age of diagnosis of pancreatic cancer was 64.48 卤7.33 years old and 48-82 years old, of which 59.77 were male.The 6-month, 1-year and 3-year survival rates of the subjects were 58.62% and 6.90%, respectively.Multivariate Cox proportional risk regression analysis showed that the survival risk ratio in early stage of pancreatic cancer was 0.21195 CI: 0.109-0.448, and that without chemotherapy was 1.91395 CI: 1.004-3.643.The rates of insulin and metformin were 40.23% and 20.69%, respectively. Whether or not to use metformin had nothing to do with the risk of death of pancreatic cancer.Conclusion: this study suggests that the prognosis of pancreatic cancer patients with diabetes is related to tumor staging, surgical treatment and chemotherapy intervention.The use of metformin does not improve the prognosis of pancreatic cancer patients with diabetes.The reasons may be related to the small sample size of the study, the failure of metformin to reach the effective blood concentration and the shorter follow-up time, and may be followed up by expanding the sample size or polycentric study.To further determine the prognostic effect of metformin on pancreatic cancer patients with diabetes mellitus, the dosage and time of metformin use and the prolongation of follow-up time were calculated to further determine the prognostic effect of metformin use on pancreatic cancer patients with diabetes mellitus.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.1;R735.1
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本文编号：1766780