Metformin Use Is Associated with Improved Survival in Patients Undergoing Resection for Pancreatic Cancer
- PMID: 27255657
- DOI: 10.1007/s11605-016-3173-4
Metformin Use Is Associated with Improved Survival in Patients Undergoing Resection for Pancreatic Cancer
Abstract
Preclinical evidence has demonstrated anti-tumorigenic effects of metformin. The effects of metformin following pancreatic cancer, however, remain undefined. We sought to assess the association between metformin use and survival using a large, nationally representative sample of patients undergoing surgery for pancreatic cancer. Patients undergoing a pancreatic resection between January 01, 2010, and December 31, 2012, were identified using the Truven Health MarketScan database. Clinical data, including history of metformin use, as well as operative details and information on long-term outcomes were collected. Multivariable Cox proportional hazards regression analysis was performed to assess the effect of metformin use on overall survival (OS). A total of 3393 patients were identified. The mean age of patients was 54.2 years (SD = 9.1 years). Roughly one half of patients were female (n = 1735, 51.1 %); 49.1 % (n = 1665) presented with a Charlson comorbidity index of 3 or greater (CCI ≥3); and 19.6 % (n = 664) had diabetes. At the time of surgery, 60.0 % (n = 2034) of patients underwent a pancreaticoduodenectomy, 35.7 % (n = 1212) a partial/distal pancreatectomy, while 4.3 % (n = 147) had a total pancreatectomy. On pathology, 1057 (31.2 %) had lymph node metastasis. Metformin use was identified in 456 patients (13.4 %) and was more commonly administered among patients without locally advanced disease (14.3 vs. 11.6 %, p = 0.038). While OS was comparable between patients within the first year of surgery (OS at 1 year 65.4 % [95 % confidence interval (CI) 63.4-67.3 %] vs. 69.2 % [95 % CI 64.2-73.4 %]), patients who received metformin demonstrated an improved OS beginning at 18 months following surgery. On multivariable analysis adjusting for patient and clinicopathologic characteristics, metformin use was independently associated with a decreased risk of mortality (hazard ratio [HR] = 0.79, 95 % CI 0.67-0.93, p = 0.005). Metformin use was associated with an improved overall survival among patients undergoing pancreatic surgery for pancreatic cancer. Further work is necessary to better understand its role in modifying cancer-specific and overall health outcomes.
Keywords: Metformin; Pancreatic cancer; Survival post-surgery.
Similar articles
-
Metformin use is associated with better survival of diabetic patients with pancreatic cancer.Clin Cancer Res. 2012 May 15;18(10):2905-12. doi: 10.1158/1078-0432.CCR-11-2994. Epub 2012 Mar 31. Clin Cancer Res. 2012. PMID: 22465831 Free PMC article.
-
Association between metformin use and mortality in patients with type 2 diabetes mellitus and localized resectable pancreatic cancer: a nationwide population-based study in korea.Oncotarget. 2017 Feb 7;8(6):9587-9596. doi: 10.18632/oncotarget.14525. Oncotarget. 2017. PMID: 28077783 Free PMC article.
-
Pre-operative dysglycemia is associated with decreased survival in patients with pancreatic neuroendocrine neoplasms.Surgery. 2020 Mar;167(3):575-580. doi: 10.1016/j.surg.2019.11.007. Epub 2019 Dec 27. Surgery. 2020. PMID: 31889543
-
Metformin is associated with survival benefit in pancreatic cancer patients with diabetes: a systematic review and meta-analysis.Oncotarget. 2017 Apr 11;8(15):25242-25250. doi: 10.18632/oncotarget.15692. Oncotarget. 2017. PMID: 28445955 Free PMC article. Review.
-
Total pancreatectomy for pancreatic ductal adenocarcinoma: review of the National Cancer Data Base.HPB (Oxford). 2016 Jan;18(1):21-8. doi: 10.1016/j.hpb.2015.07.009. Epub 2015 Dec 21. HPB (Oxford). 2016. PMID: 26776847 Free PMC article. Review.
Cited by
-
Drug Repurposing, an Attractive Strategy in Pancreatic Cancer Treatment: Preclinical and Clinical Updates.Cancers (Basel). 2021 Aug 5;13(16):3946. doi: 10.3390/cancers13163946. Cancers (Basel). 2021. PMID: 34439102 Free PMC article. Review.
-
Prognostic value of metformin in cancers: An updated meta-analysis based on 80 cohort studies.Medicine (Baltimore). 2022 Dec 9;101(49):e31799. doi: 10.1097/MD.0000000000031799. Medicine (Baltimore). 2022. PMID: 36626437 Free PMC article.
-
Diabetes mellitus as a consequence of acute severe pancreatitis: Unraveling the mystery.World J Diabetes. 2023 Aug 15;14(8):1212-1225. doi: 10.4239/wjd.v14.i8.1212. World J Diabetes. 2023. PMID: 37664472 Free PMC article. Review.
-
KRAS, YAP, and obesity in pancreatic cancer: A signaling network with multiple loops.Semin Cancer Biol. 2019 Feb;54:50-62. doi: 10.1016/j.semcancer.2017.10.007. Epub 2017 Oct 24. Semin Cancer Biol. 2019. PMID: 29079305 Free PMC article. Review.
-
Survival Benefit of Metformin Use for Pancreatic Cancer Patients Who Underwent Pancreatectomy: Results From a Meta-Analysis.Front Med (Lausanne). 2020 Jul 30;7:282. doi: 10.3389/fmed.2020.00282. eCollection 2020. Front Med (Lausanne). 2020. PMID: 32850872 Free PMC article.
References
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical