Cumulative Metformin Use and Its Impact on Survival in Gastric Cancer Patients After Gastrectomy. Issue 1 (January 2016)

• Record Type: Journal Article
• Authors: Lee, Choong-kun; Jung, Minkyu; Jung, Inkyung; Heo, Su Jin; Jeong, Yong Hyu; An, Ji Yeong; Kim, Hyoung-Il; Cheong, Jae-Ho; Hyung, Woo Jin; Noh, Sung Hoon; Kim, Hyo Song; Rha, Sun Young; Chung, Hyun Cheol
• Is Part Of: Annals of surgery. Volume 263:Issue 1(2016:Jan.)
• Publication Date: 2016-01
• Subjects: diabetes mellitus -- gastric cancer -- metformin -- survival benefit; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000001086
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Objective: The aim of this study was to evaluate the association between metformin and survival of gastric cancer (GC) patients. Background: Metformin has recently received attention as a potential anticancer treatment. However, no study has shown the survival benefit of metformin for GC patients. Methods: A total of 1974 GC patients who underwent curative gastrectomy were compared for survival according to groups; 132 diabetic patients treated with metformin, 194 diabetic patients without metformin, and 1648 non-diabetic patients. Results: During the median follow-up period of 6.2 years (interquartile range, 4.7–7.8 years), 381 patients (19.3%) died, including 302 (15.3%) who died from GC. The non-diabetic patients had significantly better recurrence-free survival (RFS; P < 0.0001), cancer-specific survival (CSS; P = 0.006), and overall survival (OS; P < 0.0001). However, the diabetic patients treated with metformin had a significantly better prognosis than those who were not (OS: hazard ratio [HR] = 0.584, 95% confidence interval [CI], 0.369–0.926; CSS: HR = 0.57, 95% CI, 0.334–0.975; RFS: HR = 0.633, 95% CI, 0.410–0.977), and metformin treatment prolonged survival in diabetic patients to a rate comparable to that in non-diabetic patients. In multivariable analysis using the Cox proportional hazard model with time-dependent covariates, each cumulative 6 months of metformin use was significantly associated with a decreased risk of recurrence, cancer-specific mortality, and all-cause mortality (RFS: HR = 0.864, 95% CI, 0.797–0.937; CSS: HR = 0.865, 95% CI, 0.782–0.958; OS: HR 0.870, 95% CI, 0.801–0.945). Conclusions: The increased cumulative duration of metformin use decreased the recurrence, all-cause mortality, and cancer-specific mortality rates among GC patients with diabetes who underwent gastrectomy. Abstract : Supplemental Digital Content is available in the text