TY - JOUR
T1 - Metformin exposure is associated with improved progression-free survival in diabetic patients after resection for early-stage non-small cell lung cancer Read at the 95th Annual Meeting of the American Association for Thoracic Surgery, Seattle, Washington, April 25-29, 2015.
AU - Medairos, Robert A.
AU - Clark, James
AU - Holoubek, Simon
AU - Kubasiak, John C.
AU - Pithadia, Ravi
AU - Hamid, Fatima
AU - Chmielewski, Gary W.
AU - Warren, William H.
AU - Basu, Sanjib
AU - Borgia, Jeffrey A.
AU - Liptay, Michael J.
AU - Seder, Christopher W.
N1 - Publisher Copyright:
© 2016 The American Association for Thoracic Surgery.
PY - 2016/7/1
Y1 - 2016/7/1
N2 - Objective There are little clinical data assessing the antineoplastic effect of metformin in patients with non-small cell lung cancer. We hypothesized that in diabetic patients undergoing pulmonary resection for early-stage non-small cell lung cancer, metformin exposure is associated with improved survival. Methods An institutional database was used to identify patients with stage I or II non-small cell lung cancer who underwent pulmonary resection between 2004 and 2013. Patients were divided into 3 cohorts: type II diabetic patients with metformin exposure (cohort A, n = 81), type II diabetic patients without metformin exposure (cohort B, n = 57), and nondiabetic individuals (cohort C, n = 77). Univariate, multivariate, and propensity-matched analyses were performed to assess progression-free and overall survivals between groups. Results A total of 215 patients with stage I and II non-small cell lung cancer treated with surgical resection were identified for analysis with a median follow-up of 19.5 months. Patients in cohort A had lower T- and N-stage tumors than those in cohorts B or C. However, on multivariate analysis adjusting for age, gender, and T and N stage, progression-free survival was greater for cohort A than cohort B (hazard ratio [HR], 0.410; 95% confidence interval, 0.199-0.874; P =.022) or cohort C (HR, 0.415; 95% confidence interval, 0.201-0.887; P =.017). Likewise, when propensity-matched analyses were performed, cohort A demonstrated a trend toward improved progression-free survival compared with cohort B (P =.057; HR, 0.44; c-statistic = 0.832) and improved progression-free survival compared with cohort C (P =.02; HR, 0.41; c-statistic = 0.843). No differences were observed in overall survival. Conclusions Metformin exposure in diabetic patients with early-stage non-small cell lung cancer may be associated with improved progression-free survival, but no effect was seen on overall survival. Further studies are warranted to evaluate if there is a therapeutic role for metformin in the treatment of non-small cell lung cancer.
AB - Objective There are little clinical data assessing the antineoplastic effect of metformin in patients with non-small cell lung cancer. We hypothesized that in diabetic patients undergoing pulmonary resection for early-stage non-small cell lung cancer, metformin exposure is associated with improved survival. Methods An institutional database was used to identify patients with stage I or II non-small cell lung cancer who underwent pulmonary resection between 2004 and 2013. Patients were divided into 3 cohorts: type II diabetic patients with metformin exposure (cohort A, n = 81), type II diabetic patients without metformin exposure (cohort B, n = 57), and nondiabetic individuals (cohort C, n = 77). Univariate, multivariate, and propensity-matched analyses were performed to assess progression-free and overall survivals between groups. Results A total of 215 patients with stage I and II non-small cell lung cancer treated with surgical resection were identified for analysis with a median follow-up of 19.5 months. Patients in cohort A had lower T- and N-stage tumors than those in cohorts B or C. However, on multivariate analysis adjusting for age, gender, and T and N stage, progression-free survival was greater for cohort A than cohort B (hazard ratio [HR], 0.410; 95% confidence interval, 0.199-0.874; P =.022) or cohort C (HR, 0.415; 95% confidence interval, 0.201-0.887; P =.017). Likewise, when propensity-matched analyses were performed, cohort A demonstrated a trend toward improved progression-free survival compared with cohort B (P =.057; HR, 0.44; c-statistic = 0.832) and improved progression-free survival compared with cohort C (P =.02; HR, 0.41; c-statistic = 0.843). No differences were observed in overall survival. Conclusions Metformin exposure in diabetic patients with early-stage non-small cell lung cancer may be associated with improved progression-free survival, but no effect was seen on overall survival. Further studies are warranted to evaluate if there is a therapeutic role for metformin in the treatment of non-small cell lung cancer.
KW - Metformin
KW - diabetes
KW - lung cancer
KW - outcomes
KW - survival
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U2 - 10.1016/j.jtcvs.2016.03.094
DO - 10.1016/j.jtcvs.2016.03.094
M3 - Article
C2 - 27157918
AN - SCOPUS:84965047944
SN - 0022-5223
VL - 152
SP - 55-61.e1
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 1
ER -