Chemotherapy: Open Access
Open Access

Abstract

The Effect of Metformin on Colorectal Carcinoma in Type 2 Diabetes Mellitus Patients: A Markov Model Analysis

Tianhong Su, Yihao Liu, Weifeng Liu, Shuling Chen, Qian Zhou, Zhenwei Peng, Sui Peng and Haipeng Xiao

Objective: Morbidity and mortality of colorectal cancer (CRC) in type 2 diabetes mellitus (T2DM) patients are higher than that of general population, the mechanism of which remains undetermined. Some studies found that metformin could lower the risk of cancer, including CRC, in T2DM patients, but others demonstrated different results. Therefore, we target to evaluate the CRC prevention effect of metformin in comparison with that of other T2DM medications from a Markov model perspective.

Methods: A Markov model simulating a randomized trial comparing metformin with non-metformin treatment in T2DM patients without CRC over 11-year time horizon was constructed based on data from 8 literatures. CRC morbidity was selected as endpoint. Monte Carlo analysis with 10,000 patients allocated for each arm was performed to assess CRC morbidity and cumulative tumor-free survival in each group.

Results: In contrast with non-metformin group, T2DM patients treated with metformin had a lower rate of CRC (1.670% vs. 2.146%). Moreover, cumulative tumor-free survival of metformin group was, slightly but significantly, better than that of non-metformin group (10.91 years vs. 10.88 years, p<0.001). Monte Carlo Strategy Selection analysis showed that metformin group had a better optimal frequency than the other one.

Conclusion: T2DM patients treated with meformin have a lower morbidity of CRC and a better cumulative tumorfree survival than that of the non-metformin group. Large scale, randomized, double blind clinical trials are needed to illustrate the role of metformin in the prevention of CRC.