Systematic review and meta-analysis of the effect of metformin treatment on overall mortality rates in women with endometrial cancer and type 2 diabetes mellitus. (July 2017)

• Record Type: Journal Article
• Authors: Perez-Lopez, Faustino R.; Pasupuleti, Vinay; Gianuzzi, Ximena; Palma-Ardiles, Gabriela; Hernandez-Fernandez, Wendy; Hernandez, Adrian V.
• Is Part Of: Maturitas. Volume 101(2017)
• Page Start: 6
• Page End: 11
• Publication Date: 2017-07
• Subjects: Endometrial cancer -- Metformin -- Type 2 diabetes mellitus -- Overall mortality; Climacteric -- Periodicals; Menopause -- Periodicals; Climacteric -- Periodicals; Geriatrics -- Periodicals; Menopause -- Periodicals; Middle Aged -- Periodicals; Climatère -- Périodiques; Ménopause -- Périodiques; Climacterium; Climacteric; Menopause; Electronic journals; Periodicals; 612.66
• DOI: 10.1016/j.maturitas.2017.04.001
• Languages: English
• ISSNs: 0378-5122

Abstract

Highlights: We performed the first meta-analysis to examine the effect of metformin on mortality in endometrial cancer. Metformin use is associated with a significant reduction in overall mortality. The findings suggest that good glycemic control may improve survival in endometrial cancer. Larger observational studies are needed to confirm this finding. Abstract: Background: Obesity, insulin resistance and type 2 diabetes mellitus (T2DM) have been associated with endometrial cancer (EC). In this systematic review and meta-analysis we evaluated the effect of metformin on clinical outcomes in patients with EC and insulin resistance or T2DM. Methods: Four research databases were searched for original articles published in all languages up to 30 October 2016. Outcomes of interest were overall mortality (OM), cancer-specific mortality, disease progression, and metastases. We performed a random effect meta-analysis of adjusted effects expressed as hazard ratios (HR); heterogeneity among studies was described with the I 2 statistic. Results: Of the 290 retrieved citations, 6 retrospective cohort studies in women with EC ( n = 4723) met the inclusion criteria, and 8.9% to 23.8% were treated with metformin; OM data was available from 5 studies. In 4 studies of EC patients ( n = 4132), metformin use was associated with a significant reduction in OM in comparison with not using metformin (adjusted HR [aHR] 0.64, 95% CI 0.45–0.89, p = 0.009). In three studies evaluating patients with EC and T2DM ( n = 2637), metformin use was associated with a significant reduction in OM (aHR 0.50, 95%CI 0.34–0.74, p = 0.0006). There was low to moderate heterogeneity of adjusted effects across studies. There was no information about the effect of metformin on cancer-specific mortality, disease progression, or metastases. Conclusions: Metformin treatment is associated with a significant reduction in OM irrespective of diabetes status in patients with EC. The survival benefit suggests that diabetes screening and maintenance of good glycemic control may improve outcomes in EC.