Abstract
BackgroundPrevious population-based studies have demonstrated an association between metformin use and improved survival among diabetic patients with cancer. We sought to analyze the effects of diabetes and its treatment in terms of the survival of patients with lung cancer.MethodsOverall, 1106 patients with non-small cell lung cancer (94.3 % with stage IV disease) were included. The outcomes were compared between the patients with (n = 186) and without diabetes (n = 920). The characteristics associated with antidiabetic treatment and proper glycemic control (defined as a mean plasma glucose <130 mg/dL) were examined at diagnosis. The overall survivals (OSs) of the different patient populations were analyzed using Kaplan-Meier curves, and a multivariate Cox proportional hazard model was used to determine the influences of the patient and tumor characteristics on survival.ResultsThe OS for the entire population was 18.3 months (95 % CI 16.1-20.4). There was no difference in the OSs of the diabetic and non-diabetic patients (18.5 vs 16.4 months, p = 0.62). The diabetic patients taking metformin exhibited a superior OS than did those on other antidiabetic treatments (25.6 vs 13.2 months, p = 0.017). Those with proper glycemic control had a better OS than did those without proper glycemic control and the non-diabetics (40.5 vs 13.2 and 18.5 months, respectively, p < 0.001). Both the use of metformin (HR 0.53, p < 0.0001 and HR 0.57, p = 0.017, respectively) and proper glycemic control (HR 0.49, p < 0.0001 and HR 0.40, p = 0.002, respectively) were significant protective factors in all and only diabetic patients, respectively.ConclusionsThe diabetic patients with proper glycemic control exhibited a better OS than did those without proper glycemic control and even exhibited a better OS than did the patients without diabetes mellitus. Metformin use was independently associated with a better OS.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-016-2658-6) contains supplementary material, which is available to authorized users.
Highlights
Previous population-based studies have demonstrated an association between metformin use and improved survival among diabetic patients with cancer
Consecutive patients diagnosed with nonsmall cell lung cancer (NSCLC) at the Instituto Nacional de Cancerología (INCan) between January 2008 and December 2014 were retrieved from our electronic medical records
Metformin was used as an antidiabetic treatment at the time of diagnosis by 59.7 % of the diabetic patients, and 31.4 % were within the predefined definition of proper glycemic control (Table 2)
Summary
Previous population-based studies have demonstrated an association between metformin use and improved survival among diabetic patients with cancer. We sought to analyze the effects of diabetes and its treatment in terms of the survival of patients with lung cancer. In Mexico, more than 95 % of all patients with nonsmall cell lung cancer (NSCLC) present with advancedstage disease at the time of diagnosis [1]. Because the prevalence of type 2 diabetes is high both worldwide and in Mexico, it is very important to understand the effects of preexisting diabetes on the survival of patients with advanced NSCLC. The physiopathology of diabetes, the effects of its treatment and the changes in different organ systems observed in diabetic patients might be associated with clinical outcomes. An elevated fasting glucose level was found to be independently associated with a significantly higher risk of mortality in patients with NSCLC [3]
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