Abstract
Previous studies have evaluated the effects of metformin use on survival outcomes in endometrial cancer, but their results are inconsistent. We conducted a systematic review and meta-analysis to provide a quantitative assessment of the drug's effects based on available evidence. We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials to identify relevant studies that evaluated the association between metformin use on survival outcomes in endometrial cancer. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated to evaluate the association of metformin use with overall survival and with progression-free survival using a fixed-effects model. A total of nine studies involving 2,016 patients with endometrial cancer were identified. In a meta-analysis of eight studies involving 1,594 individuals, metformin use was associated with significant improvements in overall survival (HR, 0.51; 95% CI, 0.41 to 0.64). Metformin users similarly showed improved progression-free survival in a meta-analysis of two studies involving 632 individuals (HR, 0.63; 95% CI, 0.46 to 0.87). In conclusion, endometrial cancer patients who use metformin show improved overall survival and progression-free survival. Further studies are required to confirm the full potential effects of metformin use on survival outcomes in endometrial cancer.
Highlights
Metformin is the most widely prescribed drug worldwide for the treatment of type 2 diabetes
With a poor prognosis associated with advancedstage or recurrent disease, the identification of potential adjuvant agents for endometrial cancer is highly desirable
After a systematic search of published and unpublished evidence, the present systematic review identified nine cohort studies with a total of 2,016 individuals that addressed the association between metformin use and survival outcomes in endometrial cancer
Summary
Metformin is the most widely prescribed drug worldwide for the treatment of type 2 diabetes. It can reduce plasma glucose levels by enhancing insulin sensitivity, which benefits patients with a variety of insulin-resistant states, including impaired glucose tolerance, polycystic ovary syndrome, obesity, and metabolic syndrome [1, 2]. Several studies have tried to evaluate the effects of metformin use on survival outcomes in endometrial cancer; their findings were inconsistent. Some studies have shown that metformin use may be associated with improved survival in endometrial cancer [13,14,15], whereas others have not shown this beneficial effect [16, 17]
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