Metformin increases pathological responses to rectal cancers with neoadjuvant chemoradiotherapy: a systematic review and meta-analysis
Abstract
Background To summarize the chemo-radio effect of metformin in rectal cancers with neoadjuvant chemoradiotherapy on pathological response, tumor regression grade (TRG), and T/N downstaging. Methods PubMed, MEDLINE, Embase, and Cochrane Database of collected reviews were searched up to June 30, 2022. This study conducted systematic review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) sheet. Odds ratios (ORs) and confidence intervals (CIs) which calculated by random-effects models were displayed in forest plots. Newcastle–Ottawa scale was used to assess the risk of bias of the observational cohort studies. Results This systematic review and meta-analysis comprised eight cohorts out of seven studies, with 2294 patients in total. We performed two-way comparison for metformin in diabetic patients vs (1) non-metformin drugs in diabetic patients and (2) nondiabetic patients. In diabetes patient studies, the metformin group had a significantly increased pathological response on TRG ( OR : 3.28, CI : 2.01–5.35, I ^2 = 0%, p < 0.001) and T downstaging ( OR : 2.14, CI : 1.24–3.67, I ^2 = 14%, p = 0.006) in comparison with a non-metformin group. When compared with nondiabetic patients, the pathological response on TRG ( OR : 2.67, CI : 1.65–4.32, I ^2 = 43%, p < 0.001) and T downstaging ( OR : 1.96, CI : 1.04–3.71, I ^2 = 66%, p = 0.04) were also higher in metformin group. The limitation was that no randomized controlled…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 2,294 participants or records.
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