Abstract
BackgroundPancreatic cancer is a highly lethal disease with a poor prognosis while metformin has been associated with a decreased risk of pancreatic cancer. Although the benefit of metformin was observed for pancreatic cancer prevention, it is not clear whether it can also affect the survival of pancreatic cancer patients with type 2 diabetes mellitus. A systematic review and meta-analysis was conducted to assess the effect of metformin on the survival of pancreatic cancer patients with type 2 diabetes mellitus.MethodsTwo independent authors searched PubMed and Web of science up to 08/07/2016. We assessed studies for eligibility, extracted data, and examined their quality, with the primary outcome as overall survival. We used published hazard ratio (HR) available or estimated based on other survival data. We pooled the data and used a random-effect model to combine direct comparisons from included articles. We also investigated treatment effects by different countries, quality and the time of metformin initiation.RESULTSWe found that there was a relative survival benefit associated with metformin treatment compared with non-metformin treatment in both overall survival (OS) ([HR] 0.84; 95% confidence interval [CI]: 0.73 – 0.96). These associations were also observed in subgroups of Asian countries and high quality articles.ConclusionsOur results support the notion that metformin maybe the best anti-diabetic medicine of choice in patients with pancreatic cancer and concurrent type 2 diabetes mellitus. The perspectives of enhancing survival of pancreatic cancer patients with diabetes mellitus by the use of metformin deserve more attention in future research and clinical practice.
Highlights
Pancreatic cancer (PC) is the fifth leading cause of cancer-related death in developed countries [1], and it is projected that the incidence is to increase by 55% from 2010 to 2030 [2]
Our results support the notion that metformin maybe the best antidiabetic medicine of choice in patients with pancreatic cancer and concurrent type 2 diabetes mellitus
It has been reported that about 1% of diabetes mellitus (DM) patients being diagnosed within 3 years www.impactjournals.com/oncotarget were diagnosed with pancreatic cancer in a populationbased cohort of 2122 people over 50 years old [33]
Summary
Pancreatic cancer (PC) is the fifth leading cause of cancer-related death in developed countries [1], and it is projected that the incidence is to increase by 55% from 2010 to 2030 [2]. Several studies have reported that obesity and type 2 diabetes mellitus (DM) are associated with increased incidence for PC [9, 10]. Metformin is the most commonly used therapy for DM worldwide [11] It works mechanistically by reducing insulin resistance and decreasing hepatic glucose production. Pancreatic cancer is a highly lethal disease with a poor prognosis while metformin has been associated with a decreased risk of pancreatic cancer. The benefit of metformin was observed for pancreatic cancer prevention, it is not clear whether it can affect the survival of pancreatic cancer patients with type 2 diabetes mellitus. A systematic review and meta-analysis was conducted to assess the effect of metformin on the survival of pancreatic cancer patients with type 2 diabetes mellitus
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