Abstract
Observational studies have demonstrated that metformin use in diabetic patients is associated with reduced cancer incidence and mortality. Here, we aimed to determine whether metformin use was associated with improved survival in patients with resected pancreatic cancer. All patients with diabetes who underwent resection for pancreatic adenocarcinoma between 12/1/1986 and 4/30/2013 at our institution were categorized by metformin use. Survival analysis was done using the Kaplan-Meier method, with log-rank test and Cox proportional hazards multivariable regression models. For analyses of our data and the only other published study, we used Meta-Analysis version 2.2. We identified 44 pancreatic cancer patients with diabetes who underwent resection of the primary tumor (19 with ongoing metformin use, 25 never used metformin). There were no significant differences in major clinical and demographic characteristics between metformin and non-metformin users. Metformin users had a better median survival than nonusers, but the difference was not statistically significant (35.3 versus 20.2 months; P = 0.3875). The estimated 2-, 3-, and 5-year survival rates for non-metformin users were 42%, 28%, and 14%, respectively. Metformin users fared better with corresponding rates of 68%, 34%, and 34%, respectively. In our literature review, which included 111 patients from the two studies (46 metformin users and 65 non-users), overall hazard ratio was 0.668 (95% CI 0.397–1.125), with P = 0.129. Metformin use was associated with improved survival outcomes in patients with resected pancreatic cancer, but the difference was not statistically significant. The potential benefit of metformin should be investigated in adequately powered prospective studies.
Highlights
Pancreatic cancer is the 10th most common cancer in the United States, with an estimated incidence for 2014 of 46,420 [1]
We evaluated the effect of metformin use on survival in patients with resectable pancreatic cancer
There were no significant differences between the two groups with regard to age, gender, race, body mass index (BMI), tumor grade, margin status, stage, surgery type, number of lymph nodes harvested, number of positive lymph nodes, ECOG status, serum albumin, and diabetes duration
Summary
Pancreatic cancer is the 10th most common cancer in the United States, with an estimated incidence for 2014 of 46,420 [1]. Metformin and Pancreatic Cancer Survival prognosis and is the fourth most common cause of cancer death in the United States, with an estimated 39,590 patients expected to die from the disease in 2014 [1]. For patients who present with unresectable disease, the 5-year survival rate is worse at 2% [2]. These dismal survival data highlight the need for better treatment strategies for the management of pancreatic cancer. The surgical treatment of pancreatic cancer has improved dramatically over the past 20 years; further refinements in surgical techniques are unlikely to result in major survival benefits
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