| Objective:The purpose of this study was to evaluate the effect of metformin combined with antineoplastic therapy on the survival and prognosis of patients with diabetes mellitus complicated with lung cancer by Meta analysis system,in order to guide clinical application.Methods:The system searches articles in PubMed,Embase,Web of Science,Wanfang database,CBM,CNKI and other databases.The time interval is set from the date of the establishment of the database to July 1,2019.Collect the periodical literature about the effect of metformin on the survival and prognosis of patients with diabetes mellitus complicated with lung cancer,screen and evaluate the quality of the literature,and include and extract the data characteristics of the relevant literature.the hazard ratio(HR)and 95% confidence interval(CI)were calculated by fixed effect or random effect model as the influence index of overall survival(OS)and progression-free survival(PFS),and subgroup analysis was carried out.Rev Man 5.3 software was used for statistical analysis.Results:A total of 15 observational studies were included,including 14 cohort studies and 1 case-control study.1.Evaluation of curative effect:1)as far as OS is concerned,patients with diabetes complicated with lung cancer who received metformin treatment compared to those who did not receive metformin.The survival time was significantly improved,and the difference was statistically significant [HR=0.81,95%CI(0.72,0.92),P=0.001].2)in terms of PFS,the progression-free survival time of patients with diabetes mellitus complicated with lung cancer treated with metformin was significantly longer than that of patients without metformin [HR=0.70,95%CI(0.62,0.80),P<0.00001].2.Subgroup analysis:1)compared with non-metformin-treated diabetic patients with lung cancer,metformin-treated patients with non-small cell lung cancer [OS:HR=0.79,95%CI(0.70,0.89),P=0.001;PFS:HR=0.72,95%CI(0.63,0.83),P<0.00001]and small-cell lung cancer [OS:HR=0.52,95%CI(0.29,0.91),P=0.02;PFS:HR=0.54,95%CI(0.34,0.84),P<0.00001] significantly reduced mortality and significantly improved survival rates.2)compared with the patients with diabetes mellitus complicated with lung cancer who did not receive metformin,the metformin treatment group could reduce the patients who received chemotherapy[OS:HR=0.63,95%CI(0.52,0.75),P<0.00001;PFS:HR=0.72,95%CI(0.62,0.84),P<0.0001]and those who were treated with radio-therapy and chemotherapy [OS:HR=0.83,95%CI(0.78,0.87),P<0.00001].The low risk of death and improved survival prognosis was not observed in patients who received simultaneous radiotherapy and chemotherapy.3)compared with patients with diabetes mellitus complicated with lung cancer who were not treated with metformin,Chinese patients treated with metformin [OS: HR=0.67,95%CI(0.53,0.85),P=0.0007;PFS:HR=0.70,95%CI(0.60,0.80),P<0.00001] had significant survival benefits,while no such survival benefits were observed in the United States and other western countries.Conclusion:1.Metformin combined with antineoplastic therapy is significantly effective in patients with diabetes mellitus complicated with lung cancer.2.Compared with non-small cell lung cancer,the survival benefit of small cell lung cancer is more obvious.3.Metformin combined with anti-tumor therapy,combined with chemotherapy alone to reduce the risk of death is the most significant.Comprehensive therapy took the second place,but this relationship was not observed in combination with simultaneous radiotherapy and chemotherapy.4.Metformin combined with anti-tumor therapy can significantly benefit the survival of patients with diabetes mellitus and lung cancer in China,but not in the United States and other western countries. |
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