二甲双胍辅助治疗合并2型糖尿病的恶性肿瘤患者的专家共识（2022年版）

doi:10.19401/j.cnki.1007-3639.2022.11.011

摘要/Abstract

摘要：

恶性肿瘤是近年来慢性非传染性疾病死亡的主要原因，也是影响人类预期寿命的最重要原因，其治疗效果差，预后不良。二甲双胍为2型糖尿病首选的降糖药物，其抗肿瘤的作用得到越来越多同行的认可。然而，目前国内外缺乏独立的临床指南、共识及大型前瞻性临床试验。本共识旨在为二甲双胍在抗肿瘤方面的临床应用提供参考。对于大多数合并2型糖尿病的恶性肿瘤患者，推荐联合使用二甲双胍治疗，可以辅助抗肿瘤及增强化疗药物敏感性，降低多种恶性肿瘤的发病率、转移率，从而降低死亡率;对于少部分合并2型糖尿病的恶性肿瘤患者，不推荐也不反对使用二甲双胍，如雌激素受体（estrogen receptor，ER）阴性或三阴性乳腺癌;对于大部分不合并糖尿病的恶性肿瘤患者，不推荐使用二甲双胍，如肺癌、结直肠癌、前列腺癌等;而对于极少部分不合并糖尿病的恶性肿瘤患者，在充分知情同意的情况下，可使用二甲双胍。

关键词: 二甲双胍, 恶性肿瘤, 专家共识, 辅助治疗

Abstract:

Malignant tumors are the leading causes of death from chronic non-communicable diseases and the most important factors influencing life expectancy in recent year, with poor treatment response and poor prognosis. Metformin, the preferred hypoglycemic drug for diabetes mellitus type 2, has been recognized by more and more peers for its anti-tumor effect. However, there is no independent clinical guideline, consensus and large prospective clinical trial at home and abroad. This expert guideline aimed to provide clinical practice reference for the application of metformin in anti-tumor treatment. This expert consensus recommends that metformin, used in combination for most malignancies with diabetes mellitus type 2, can assist in anti-tumor effect and enhance chemotherapeutic drug sensitivity, and reduce the morbidity and mortality of multiple malignancies. Metformin is not recommended or opposed for a small number of malignancies complicated with diabetes mellitus type 2, such as estrogen receptor (ER)-negative or triple-negative breast cancer. Metformin is not recommended for most malignant tumors without diabetes, such as lung cancer, colorectal cancer and prostate cancer. However, metformin can be used with informed consent in a very small number of malignancies without diabetes.

Key words: Metformin, Malignant tumors, Expert consensus, Adjuvant therapy

中图分类号:

R730.5

中国抗癌协会肿瘤内分泌专业委员会. 二甲双胍辅助治疗合并2型糖尿病的恶性肿瘤患者的专家共识（2022年版）[J]. 中国癌症杂志, 2022, 32(11): 1121-1132.

Society of Onco-endocrinology of Chinese Anti-Cancer Association. Expert consensus on metformin adjuvant therapy in malignant tumor patients with diabetes mellitus type 2 (2022 edition)[J]. China Oncology, 2022, 32(11): 1121-1132.

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分级	具体描述
证据质量分级
高等	对观察值非常有把握，观察值接近真实值，进一步研究也不可能改变观察值
中等	对观察值有中等程度的把握，观察值有可能接近真实值，也有可能差别很大。进一步研究可能改变观察值
低等	对观察值的把握有限，观察值可能与真实值有很大差别。进一步研究很有可能改变评估结果
极低等	对观察值没有把握
推荐强度分级
强推荐	绝大多数患者或个体会遵循推荐意见
弱推荐	多数患者或个体倾向于遵循推荐意见，但是推荐意见并不适合所有人，因此需要医患共同决策

肿瘤类型	推荐意见及级别
肿瘤类型	糖尿病	证据质量	推荐强度	非糖尿病	证据质量	推荐强度
乳腺癌	ER阳性/HER2阴性的乳腺癌患者使用二甲双胍	高等	强推荐	在充分知情同意情况下，ER阳性/HER2阴性的乳腺癌患者可使用二甲双胍	低等	弱推荐
	ER阴性或TNBC不推荐也不反对使用二甲双胍	中等	强推荐
肺癌	优先使用二甲双胍辅助治疗	高等	强推荐	使用二甲双胍	低等	弱推荐
结直肠癌	常规使用可耐受的二甲双胍剂量范围（500~2 550 mg），而结直肠癌术后患者不推荐也不反对使用二甲双胍	中等	强推荐	使用二甲双胍	低等	弱推荐
前列腺癌	常规使用二甲双胍	中等	强推荐	使用二甲双胍	低等	弱推荐
胃癌	使用可耐受最大剂量的二甲双胍	中等	强推荐	使用二甲双胍	低等	弱推荐
肝癌	使用可耐受最大剂量的二甲双胍	中等	强推荐	使用二甲双胍	低等	弱推荐
子宫内膜癌	使用可耐受最大剂量的二甲双胍	中等	强推荐	1型子宫内膜癌，不推荐也不反对使用二甲双胍;2型子宫内膜癌，不推荐使用二甲双胍	低等	弱推荐