老年2型糖尿病与恶性肿瘤相关性的研究进展

doi:10.3969/j.issn.1003-9198.2025.02.023

摘要/Abstract

摘要： 随着人口老龄化,老年T2DM与恶性肿瘤的关联备受关注。在临床流行病学方面,老年T2DM病人癌症发病率呈增加趋势,不过相对风险随年龄增长而减弱。就临床风险因素而言,年龄是传统危险因素,年轻时被诊断为T2DM患癌相对风险高,老年后T2DM促肿瘤作用或减弱;性别上,男女在特定部位癌症发病率有差异;血糖水平与胰腺癌、消化道癌发生联系较紧密;糖尿病病程与癌症风险关系尚不明确,仍待验证。降糖药物中,二甲双胍可降低癌症风险,胰岛素等其他药物对癌症的影响不一。未来仍需从多方面深入研究,为临床防治工作提供更加全面和深入的理论支持。

关键词: 2型糖尿病, 老年人, 恶性肿瘤, 危险因素

Abstract: With the aging of the population, the association between type 2 diabetes mellitus(T2DM) and malignant tumors in the elderly has attracted much attention. There is an increasing trend in the incidence rate of cancer in the elderly patients with T2DM, but the relative risk decreases with age.Age is a traditional clinical risk factor for cancer. Those diagnosed with T2DM at a younger age have a relatively higher cancer risk, and the tumor-promoting effect of T2DM may weaken in old age. There are differences in the incidence of cancer in specific sites between men and women. Blood glucose level is closely related to the occurrence of pancreatic cancer and digestive tract cancer. The relationship between the duration of diabetes and cancer risk remains unclear and needs verification. Among antidiabetic drugs, metformin can reduce cancer risk, while the impacts of insulin and other drugs are unclear. In the future, advanced researches are still needed to provide more comprehensive theoretical support for clinical prevention and treatment.

Key words: type 2 diabetes mellitus, aged, cancer, risk factor

中图分类号:

R 587.1
R 73

费勤楠, 陈星岚, 欧阳晓俊, 顾刘宝. 老年2型糖尿病与恶性肿瘤相关性的研究进展[J]. 实用老年医学, 2025, 39(2): 212-216.

FEI Qinnan, CHEN Xinglan, OUYANG Xiaojun, GU Liubao. A review of association between type 2 diabetes mellitus and malignant tumors in elderly patients[J]. Practical Geriatrics, 2025, 39(2): 212-216.

参考文献

[1] SUN H, SAEEDI P, KARURANGA S, et al. IDF Diabetes Atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045[J]. Diabetes Res Clin Pract, 2022, 183: 109119.
[2] SINCLAIR A, SAEEDI P, KAUNDAL A, et al.Diabetes and global ageing among 65-99-year-old adults: findings from the international diabetes federation diabetes atlas, 9^th edition[J]. Diabetes Res Clin Pract, 2020, 162: 108078.
[3] SIEGEL R L, MILLER K D, WAGLE N S, et al. Cancer statistics, 2023[J]. CA Cancer J Clin, 2023, 73(1): 17-48.
[4] QI J, LI M, WANG L, et al.National and subnational trends in cancer burden in China, 2005-20: an analysis of national mortality surveillance data[J]. Lancet Public Health, 2023, 8(12): e943-e955.
[5] 李宁, 吴鹏, 申郁冰, 等. 2020–2030年中国4种主要癌症相关死亡率的预测[J]. 癌症, 2022, 41(1): 8-17.
[6] JOSLIN E P, LOMBARD H L, BURROWS R E, et al.Diabetes and cancer[J]. N Engl J Med, 1959, 260(10): 486-488.
[7] TSILIDIS K K, KASIMIS J C, LOPEZ D S, et al.Type 2 diabetes and cancer: umbrella review of meta-analyses of observational studies[J]. BMJ, 2015, 350: g7607.
[8] LING S, BROWN K, MIKSZA J K, et al.Association of type 2 diabetes with cancer: a meta-analysis with bias analysis for unmeasured confounding in 151 cohorts comprising 32 million people[J]. Diabetes Care, 2020, 43(9): 2313-2322.
[9] WANG M, HU R Y, WU H B, et al.Cancer risk among patients with type 2 diabetes mellitus: a population-based prospective study in China[J]. Sci Rep, 2015, 5: 11503.
[10] LI Y, TIAN J, HOU T, et al.Association between age at diabetes diagnosis and subsequent incidence of cancer: a longitudinal population-based cohort[J]. Diabetes Care, 2024, 47(3): 353-361.
[11] YANG Z, WU Y, XU L, et al.Age at diagnosis modifies associations of type 2 diabetes with cancer incidence and mortality: a retrospective matched-cohort study[J]. Diabetologia, 2023, 66(8): 1450-1459.
[12] OHKUMA T, PETERSS A E, WOODWARD M. Sex differences in the association between diabetes and cancer: a systematic review and meta-analysis of 121 cohorts including 20 million individuals and one million events[J]. Diabetologia, 2018, 61(10): 2140-2154.
[13] LIAO W C, TU Y K, WU M S, et al.Blood glucose concentration and risk of pancreatic cancer: systematic review and dose-response meta-analysis[J]. BMJ, 2015, 350: g7371.
[14] MUELLER A M, MEIER C R, JICK S S, et al.Weight change and blood glucose concentration as markers for pancreatic cancer in subjects with new-onset diabetes mellitus: a matched case-control study[J]. Pancreatology, 2019, 19(4): 578-586.
[15] CAO L, WANG T, LI H, et al.Type 2 diabetes, glycaemic traits and upper gastrointestinal cancer risk: a prospective cohort study[J]. J Epidemiol Community Health, 2024: jech-2023-221351.
[16] HU Y, ZHANG X, MA Y, et al.Incident type 2 diabetes duration and cancer risk: a prospective study in two US cohorts[J]. J Natl Cancer Inst, 2021, 113(4): 381-389.
[17] LAWLER T, WALTS Z L, STEINWANDEL M, et al.Type 2 diabetes and colorectal cancer risk[J]. JAMA Netw Open, 2023, 6(11): e2343333.
[18] SHEN B, LI Y, SHENG C S, et al.Association between age at diabetes onset or diabetes duration and subsequent risk of pancreatic cancer: results from a longitudinal cohort and Mendelian randomization study[J]. Lancet Reg Health West Pac, 2022, 30: 100596.
[19] ZACCARDI F, LING S, BROWN K, et al.Duration of type 2 diabetes and incidence of cancer: an observational study in England[J]. Diabetes Care, 2023, 46(11): 1923-1930.
[20] GALAL M A, AL-RIMAWI M, HAJEER A, et al.Metformin: a dual-role player in cancer treatment and prevention[J]. Int J Mol Sci, 2024, 25(7): 4083.
[21] EVANS J M M, DONNELLY L A, EMSLIE-SMITH A M, et al.Metformin and reduced risk of cancer in diabetic patients[J]. BMJ, 2005, 330(7503): 1304-1305.
[22] WEN J, YI Z, CHEN Y, et al.Efficacy of metformin therapy in patients with cancer: a meta-analysis of 22 randomised controlled trials[J]. BMC Med, 2022, 20(1): 402.
[23] ANTWI S O, LI Z, MODY K, et al.Independent and joint use of statins and metformin by elderly patients with diabetes and overall survival following HCC diagnosis[J]. J Clin Gastroenterol, 2020, 54(5): 468-476.
[24] POLLAK M. Insulin and insulin-like growth factor signalling in neoplasia[J]. Nat Rev Cancer, 2008, 8(12): 915-928.
[25] WU J W, FILION K B, AZOULAY L, et al.Effect of long-acting insulin analogs on the risk of cancer: a systematic review of observational studies[J]. Diabetes Care, 2016, 39(3): 486-494.
[26] DICEMBRINI I, NREU B, MONTEREGGI C, et al.Risk of cancer in patients treated with dipeptidyl peptidase-4 inhibitors: an extensive meta-analysis of randomized controlled trials[J]. Acta Diabetol, 2020, 57(6): 689-696.
[27] LI Z, LIN C, ZHOU J, et al.Dipeptidyl peptidase 4-inhibitor treatment was associated with a reduced incidence of neoplasm in patients with type 2 diabetes: a meta-analysis of 115 randomized controlled trials with 121961 participants[J]. Expert Opin Investig Drugs, 2022, 31(9): 957-964.
[28] ELASHOFF M, MATVEYENKO A V, GIER B, et al.Pancreatitis, pancreatic, and thyroid cancer with glucagon-like peptide-1-based therapies[J]. Gastroenterology, 2011, 141(1): 150-156.
[29] MONAMI M, NREU B, SCATENA A, et al.Safety issues with glucagon-like peptide-1 receptor agonists(pancreatitis, pancreatic cancer and cholelithiasis): data from randomized controlled trials[J]. Diabetes Obes Metab, 2017, 19(9): 1233-1241.
[30] DANKNER R, MURAD H, AGAY N, et al.Glucagon-like peptide-1 receptor agonists and pancreatic cancer risk in patients with type 2 diabetes[J]. JAMA Netw Open, 2024, 7(1): e2350408.
[31] PINTO L C, FALCETTA M R, RADOS D V, et al.Glucagon-like peptide-1 receptor agonists and pancreatic cancer: a meta-analysis with trial sequential analysis[J]. Sci Rep, 2019, 9(1): 2375.
[32] ESPINOSA DE YCAZA A E, BRITO J P, MCCOY R G, et al.Glucagon-like peptide-1 receptor agonists and thyroid cancer: a narrative review[J]. Thyroid, 2024, 34(4): 403-418.
[33] KOEPSELL H.The Na⁺-D-glucose cotransporters SGLT1 and SGLT2 are targets for the treatment of diabetes and cancer[J]. Pharmacol Ther, 2017, 170: 148-165.
[34] BENEDETTI R, BENINCASA G, GLASS K, et al.Effects of novel SGLT2 inhibitors on cancer incidence in hyperglycemic patients: a meta-analysis of randomized clinical trials[J]. Pharmacol Res, 2022, 175: 106039.
[35] SPIAZZI B F, NAIBO R A, WAYERBACHER L F, et al.Sodium-glucose cotransporter-2 inhibitors and cancer outcomes: a systematic review and meta-analysis of randomized controlled trials[J]. Diabetes Res Clin Pract, 2023, 198: 110621.
[36] XU B, KANG B, LI S, et al.Sodium-glucose cotransporter 2 inhibitors and cancer: a systematic review and meta-analysis[J]. J Endocrinol Invest, 2024, 47(10): 2421-2436.
[37] HENDRIKS A M, SCHRIJNDERS D, KLEEFSTRA N, et al. Sulfonylurea derivatives and cancer, friend or foe?[J]. Eur J Pharmacol, 2019, 861:172598.
[38] TUCCORI M, WU J W, YIN H, et al. The use of glyburide compared with other sulfonylureas and the risk of cancer in patients with type 2 diabetes[J]. Diabetes Care, 2015, 38(11): 2083-2089.
[39] CHANG C H, LIN J W, WU L C, et al.Oral insulin secretagogues, insulin, and cancer risk in type 2 diabetes mellitus[J]. J Clin Endocrinol Metab, 2012, 97(7): E1170-E1175.
[40] ZHAO H, LIU Z, ZHUO L, et al.Sulfonylurea and cancer risk among patients with type 2 diabetes: a population-based cohort study[J]. Front Endocrinol, 2022, 13: 874344.