Therapeutic Effect Of Metformin Combined With Concurrent Chemoradiotherapy In Locally Advanced Esophageal Squamous Cell Carcinoma

BackgroundIn recent years,the classic hypoglycemic agent metformin has being widely concerned in the prevention and treatment of malignant tumors.A number of studies have shown that metformin can prevent the occurrence of tumors and may inhibit the development of tumors.In addition,its sensitizing effect on chemoradiotherapy was also reflected in some tumors.Based on these findings,metformin is likely to become a new generation of anti-cancer drugs.The incidence and mortality of esophageal cancer in China is on the rise.For patients without surgical indications,radiotherapy and chemotherapy in esophageal cancer plays an important role.However,for patients with local progression or distant metastasis of esophageal cancer,the efficacy of radiotherapy and chemotherapy is limited,and the adverse reaction tolerance is poor.The prognosis of patients is difficult to improve.Therefore,it is important to seek new sensitizer for chemoradiotherapy and increase the efficacy of chemoradiotherapy without increasing adverse reactions.Metformin has potential anti-cancer value,but clinical studies related to esophageal cancer are currently relatively rare and require further exploration.PurposeRetrospective analysis of whether metformin has an effect on the efficacy,side effects and prognosis of concurrent chemoradiotherapy in patients with locally advanced esophageal squamous cell carcinoma.MethodPatients who were diagnosed with esophageal squamous cell carcinoma at the North Jiangsu People's Hospital from June 2012 to June 2016 were collected.According to the inclusion criteria of this study,a total of 186 patients with locally advanced and concurrent chemoradiotherapy were included.Grouping is determined according to whether they have diabetes and whether patients with diabetes take metformin.Finally,46 patients with type 2 diabetes mellitus and oral metformin were defined as group A,45 patients with type 2 diabetes mellitus without metformin were defined as group B,and 95 patients without diabetes group were defined as group C.The clinical information of patients was collected and followed up by medical records,outpatient surveys and telephone calls.The general situation of the three groups of patients,the efficacy after radiotherapy and chemotherapy,progression-free survival(PFS)and radiotherapy and chemotherapy-related adverse reactions were statistically analyzed to compare whether there were statistical differences between the three groups.Statistical methods:statistical analysis using SPSS22.0.The measurement data that conforms to the normal distribution and homogeneity of variance is expressed by(mean±standard deviation),using one-way analysis of variance.The measurement data that do not conform to a normal distribution are represented by the median(quartile)and the nonparametric test is used.The count data is expressed as a rate,using a chi-square test or Fisher's exact probability method.The grade data is tested using the Kruskal-Wallis H test.Survival curves were plotted by Kaplan-Meier method and survival analysis was performed using log-rank method.The threshold for statistical significance was set at p<0.05.Result1.There was no statistical difference in the general data of the three groups(P>0.05),which was comparable.2.The objective response rate(ORR)of patients in group A,B and C were 56.2%,44.4%and 32.6%.There were statistical differences between the three groups(P<0.05).Group A is respectively compared with group B and C,the ORR was significantly increased,and there was statistical difference(P<0.05).There was no significant difference between group B and group C(P>0.05).The disease control rate(DCR)in group A,B and C were 95.7%,84.4%,and 85.3%,respectively.And there was no significant difference in disease control rate(DCR)between the three groups(P>0.05).3.The median PFS of the three groups A,B and C were 18.0 months(95%Cl:14.0-22.0),8.0 months months(95%Cl:5.6-10.4),and 10.0 months(95%Cl:7.6-12.4).And there were statistical differences among the three groups(P<0.05).The median PFS was significantly prolonged in group A compared with group B and C(P<0.05).There was no significant difference in median PFS between group B and group C(P>0.05).4.There was no significant difference in the incidence of adverse reactions of radiotherapy and chemotherapy and the distribution of each adverse reaction in the three groups A,B and C(P>0.05).ConclusionMetformin can improve the efficacy of concurrent chemoradiotherapy and improve the prognosis of patients with locally advanced esophageal squamous cell carcinoma,and does not increase the adverse reactions of chemoradiotherapy.