Dataset Information

Association of metformin intake with bladder cancer risk and oncologic outcomes in type 2 diabetes mellitus patients: A systematic review and meta-analysis.

ABSTRACT:

Background

Recent clinical trials indicated that metformin intake might play a protective role in the incidence and oncologic outcomes of various cancers. However, its protective effect on bladder cancer remains uncertain.

Methods

We performed a meta-analysis to investigate the association between metformin intake and bladder cancer risk as well as oncologic outcomes in diabetes mellitus (DM) patients. A comprehensive literature search was performed using PubMed, Embase, and the Cochrane Central Search Library in December 2017. Hazard ratio (HR) with 95% confidence interval (CI) was pooled.

Results

A total of 9 retrospective cohort studies with 1,270,179 patients were included. A meta-analysis revealed that metformin intake was associated with an increased recurrence-free survival (HR?=?0.55, 95% confidence interval [CI]?=?0.35-0.88; P?=?.01; I?=?64%), improved progression-free survival (HR?=?0.70, 95% CI?=?0.51-0.96; P?=?.03; I?=?33%), and prolonged cancer-specific survival (HR?=?0.57, 95% CI?=?0.40-0.81; P?=?.002; I?=?0%). However, results demonstrated that metformin intake was not associated with a decreased incidence of bladder cancer (HR?=?0.82, 95% CI?=?0.61-1.09; P?=?.17; I?=?85%) or an increased overall survival in bladder cancer patients (HR?=?0.83, 95% CI?=?0.47-1.44; P?=?.50; I?=?64%).

Conclusion

The present meta-analysis indicated that metformin intake could improve the prognosis of bladder cancer patients. Further prospective cohort studies and mechanistic studies are still required to determine the precise role of metformin in the initiation and progression of bladder cancer.

SUBMITTER: Hu J

PROVIDER: S-EPMC6078654 | biostudies-literature | 2018 Jul

REPOSITORIES: biostudies-literature

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Publications

Association of metformin intake with bladder cancer risk and oncologic outcomes in type 2 diabetes mellitus patients: A systematic review and meta-analysis.

Hu Jiao J Chen Jin-Bo JB Cui Yu Y Zhu Ye-Wen YW Ren Wen-Biao WB Zhou Xu X Liu Long-Fei LF Chen He-Qun HQ Zu Xiong-Bing XB

Medicine 20180701 30

<h4>Background</h4>Recent clinical trials indicated that metformin intake might play a protective role in the incidence and oncologic outcomes of various cancers. However, its protective effect on bladder cancer remains uncertain.<h4>Methods</h4>We performed a meta-analysis to investigate the association between metformin intake and bladder cancer risk as well as oncologic outcomes in diabetes mellitus (DM) patients. A comprehensive literature search was performed using PubMed, Embase, and the C ...[more]

PMID: 30045293

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Project description:ImportanceAdults with comorbidity have less physiological reserve and an increased rate of postoperative mortality and readmission after the stress of a major surgical intervention.ObjectiveTo assess postoperative mortality and readmission among individuals with diabetes with or without preoperative prescriptions for metformin.Design, setting, and participantsThis cohort study obtained data from the electronic health record of a multicenter, single health care system in Pennsylvania. Included were adults with diabetes who underwent a major operation with hospital admission from January 1, 2010, to January 1, 2016, at 15 community and academic hospitals within the system. Individuals without a clinical indication for metformin therapy were excluded. Follow-up continued until December 18, 2018.ExposuresPreoperative metformin exposure was defined as 1 or more prescriptions for metformin in the 180 days before the surgical procedure.Main outcomes and measuresAll-cause postoperative mortality, hospital readmission within 90 days of discharge, and preoperative inflammation measured by the neutrophil to leukocyte ratio were compared between those with and without preoperative prescriptions for metformin. The corresponding absolute risk reduction (ARR) and adjusted hazard ratio (HR) with 95% CI were calculated in a propensity score-matched cohort.ResultsAmong the 10 088 individuals with diabetes who underwent a major surgical intervention, 5962 (59%) had preoperative metformin prescriptions. A total of 5460 patients were propensity score-matched, among whom the mean (SD) age was 67.7 (12.2) years, and 2866 (53%) were women. In the propensity score-matched cohort, preoperative metformin prescriptions were associated with a reduced hazard for 90-day mortality (adjusted HR, 0.72 [95% CI, 0.55-0.95]; ARR, 1.28% [95% CI, 0.26-2.31]) and hazard of readmission, with mortality as a competing risk at both 30 days (ARR, 2.09% [95% CI, 0.35-3.82]; sub-HR, 0.84 [95% CI, 0.72-0.98]) and 90 days (ARR, 2.78% [95% CI, 0.62-4.95]; sub-HR, 0.86 [95% CI, 0.77-0.97]). Preoperative inflammation was reduced in those with metformin prescriptions compared with those without (mean neutrophil to leukocyte ratio, 4.5 [95% CI, 4.3-4.6] vs 5.0 [95% CI, 4.8-5.3]; P < .001). E-value analysis suggested robustness to unmeasured confounding.Conclusions and relevanceThis study found an association between metformin prescriptions provided to individuals with type 2 diabetes before a major surgical procedure and reduced risk-adjusted mortality and readmission after the operation. This association warrants further investigation.

Dataset Information

Association of metformin intake with bladder cancer risk and oncologic outcomes in type 2 diabetes mellitus patients: A systematic review and meta-analysis.

Background

Methods

Results

Conclusion

Publications

Association of metformin intake with bladder cancer risk and oncologic outcomes in type 2 diabetes mellitus patients: A systematic review and meta-analysis.

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