期刊
GYNECOLOGIC ONCOLOGY
卷 165, 期 1, 页码 60-66出版社
ACADEMIC PRESS INC ELSEVIER SCIENCE
DOI: 10.1016/j.ygyno.2022.01.022
关键词
Metformin; Ovarian; Endometrial; Breast cancer
This study evaluates the association between metformin and survival in women with Type 2 diabetes (T2DM) and hormonally mediated cancers. The results show that metformin users have increased survival compared to users of tier 2 and tier 3 medications, even after accounting for surrogates of diabetes progression.
Objective. Evaluate the association between metformin and survival inwomen with Type 2 diabetes (T2DM) and breast, endometrial and ovarian cancer-3 hormonally mediated cancers. Methods. We evaluated outcomes in a cohort of 6225 women with T2DM with a new diagnosis of ovarian, breast or endometrial cancer from 2010 to 2019. We classified glycemic medications at time of first cancer diagnosis into 3 tiers in accordance with ADA guidelines. Approaches compared: (i) metformin (tier 1) vs. no glycemic medication, (ii) metformin vs tier 2 medications (sulfonylureas, thiazolidinediones, SGLT2-inhibitors, DPP4-inhibitors, alpha glucosidase-inhibitors, GLP-1 agonists), (iii) metformin vs tier 3 medications (insulins, amylinomimetics), and (iv) tier 2 vs tier 3 medications. Analyses included Cox proportional-hazards models, Kaplan-Meier curves, and conditional logistic regression in a risk set-sampled nested case-control matched on T2DM duration- all modeling survival. Models were adjusted for demographics, cancer type, A1C, T2DM duration, and number of office visits and hospitalizations. Results. Metformin was the most used medication (n=3232) and consistently demonstrated survival benefit compared with tier 2 and 3 medications, across all methods. Tier 3-users demonstrated highest risk of death when compared to metformin rather than tier 2 [adjHR = 1.83 (95% CI: 1.58, 2.13) vs. adjHR = 1.32 (95% CI: 1.11, 1.57)], despite similar baseline profiles between tier 1 and 2 users. Conclusions. Metformin users experienced increased survival even after accounting for surrogates of diabetes progression. Benefit extended beyond that seen in tier 2-users. Our findings, consistent with prior studies, indicate metformin use improves survival in women with T2DM and hormonally mediated women's cancers. (C) 2022 Elsevier Inc. All rights reserved.
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