Cancer Res Treat.  2017 Jan;49(1):29-36. 10.4143/crt.2016.128.

Association between Metformin Use and Survival in Nonmetastatic Rectal Cancer Treated with a Curative Resection: A Nationwide Population Study

• Ki YJ
• Kim HJ
• Kim MS
• Park CM
• Ko MJ
• Seo YS
• Moon SM
• Choi JA

• KMID: 2367500
• DOI: http://doi.org/10.4143/crt.2016.128

Abstract

PURPOSE
Metformin is associated with an anticancer effect. However, the effects of metformin in rectal cancer are controversial. This study investigated the impact of metformin on the survival of patients with diabetes mellitus and nonmetastatic rectal cancer who underwent curative surgery.
MATERIALS AND METHODS
The database was provided by the Korea Center Cancer Registry and National Health Insurance Service of the Republic of Korea. A cohort of patients with newly diagnosed rectal cancer between 2005 and 2011 was identified. Drug exposure was defined as receiving the oral hypoglycemic agent for at least 90 days over the period from 6 months before the initial diagnosis of rectal cancer to the last follow-up.
RESULTS
A total of 4,503 patients were prescribed oral hypoglycemic agents and classified as the diabetic group, of which 3,694 patients received metformin for at least 90 days. Unadjusted analyses showed a significantly higher overall survival (hazard ratio, 0.596; 95% confidence interval, 0.506 to 0.702) and rectal cancer-specific survival (hazard ratio, 0.621; 95% confidence interval, 0.507 to 0.760) in the metformin group than in the nonmetformin group. The adjusted overall survival (hazard ratio, 0.631; 95% confidence interval, 0.527 to 0.755) and cancer-specific survival (hazard ratio, 0.598; 95% confidence interval, 0.479 to 0.746) in the group with a medication possession ratio of 80% or greater was significantly higher than in the group with a medication possession ratio of less than 80%.
CONCLUSION
Metformin use is associated with overall and cancer-specific survival in diabetic patients with a nonmetastatic rectal cancer treated with a curative resection.

Keyword

Rectal neoplasms; Metformin; Diabetes mellitus; Colorectal surgery; Survival

MeSH Terms

Cohort Studies
Colorectal Surgery
Diabetes Mellitus
Diagnosis
Follow-Up Studies
Humans
Hypoglycemic Agents
Korea
Metformin*
National Health Programs
Rectal Neoplasms*
Republic of Korea
Hypoglycemic Agents
Metformin

Figure

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  Fig. 1. Flowchart: study population. ICD-10, International Classification of Disease, 10th revision; SEER, Surveillance Epidemiology and End Result.

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  Fig. 2. Survival curves comparing metformin and nonmetformin use in rectal cancer patients. (A) Overall survival. (B) Rectal cancer-specific survival. RMST, restricted mean survival time.

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  Fig. 3. Survival curves comparing MPR levels for metformin in patients with rectal cancer. (A) Overall survival. (B) Rectal cancer-specific survival. MPR, medication possession ratio; RMST, restricted mean survival time.

Reference

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