Metformin Use and Lung Cancer Risk in Diabetic Patients: A Systematic Review and Meta-Analysis
Why this work is in the frame
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Bibliographic record
Abstract
Background . Antidiabetic medications (ADMs) can alter the risk of different types of cancer, but the relationship between lung cancer incidence and metformin remains controversial. Our aim was to quantitatively estimate the relationship between incidences of lung cancer and metformin in patients with diabetes in this meta-analysis. Methods . We performed a search in PubMed, Embase, ISI Web of Science, and Cochrane Library until September 20, 2017. The odds ratio (OR), relative risk (RR) or hazard ratio (HR), and 95% confidence interval (95% CI) were estimated using the random-effect model. The Newcastle-Ottawa Scale (NOS) was used to assess the study quality. Results . A total of 13 studies (10 cohort studies and 3 case-control studies) were included in the meta-analysis. Compared to nonmetformin users, metformin probably decreased lung cancer incidence in diabetic patients (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M1"><mml:mtext>RR</mml:mtext><mml:mo>=</mml:mo><mml:mn>0.89</mml:mn></mml:math>; 95% CI, 0.83-0.96; <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M2"><mml:mi>P</mml:mi><mml:mo>=</mml:mo><mml:mn>0.002</mml:mn></mml:math>) with significant heterogeneity (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M3"><mml:mi>Q</mml:mi><mml:mo>=</mml:mo><mml:mn>35.47</mml:mn></mml:math>, <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M4"><mml:msup><mml:mrow><mml:mi>I</mml:mi></mml:mrow><mml:mrow><mml:mn>2</mml:mn></mml:mrow></mml:msup><mml:mo>=</mml:mo><mml:mn>66</mml:mn></mml:math>%, <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M5"><mml:mi>P</mml:mi><mml:mo>=</mml:mo><mml:mn>0.0004</mml:mn></mml:math>). Subgroup analysis showed that cohort studies (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M6"><mml:mtext>RR</mml:mtext><mml:mo>=</mml:mo><mml:mn>0.91</mml:mn></mml:math>; 95% CI, 0.85-0.98; <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M7"><mml:mi>P</mml:mi><mml:mo>=</mml:mo><mml:mn>0.008</mml:mn></mml:math>), location in Europe (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M8"><mml:mtext>RR</mml:mtext><mml:mo>=</mml:mo><mml:mn>0.90</mml:mn></mml:math>; 95% CI, 0.86-0.94; <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M9"><mml:mi>P</mml:mi><mml:mo><</mml:mo><mml:mn>0.0001</mml:mn></mml:math>), the control drug of the sulfonylurea group (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M10"><mml:mtext>RR</mml:mtext><mml:mo>=</mml:mo><mml:mn>0.91</mml:mn></mml:math>; 95% CI, 0.86-0.96; <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M11"><mml:mi>P</mml:mi><mml:mo>=</mml:mo><mml:mn>0.001</mml:mn></mml:math>), and adjusting for smoking (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M12"><mml:mtext>RR</mml:mtext><mml:mo>=</mml:mo><mml:mn>0.86</mml:mn></mml:math>; 95% CI, 0.75-1.00; <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M13"><mml:mi>P</mml:mi><mml:mo>=</mml:mo><mml:mn>0.05</mml:mn></mml:math>) may be related to lower lung cancer risk. No significant publication bias was detected using a funnel plot. Conclusion . Metformin use was related to a lower lung cancer risk in diabetic patients compared to nonusers, but this result was retrieved from observational studies and our findings need more well-designed RCTs to confirm the association.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.005 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it