Cumulative metformin use and its impact on survival in gastric cancer patients after gastrectomy

Choong Kun Lee, Minkyu Jung, Inkyung Jung, Su Jin Heo, Yong Hyu Jeong, Ji Yeong An, Hyoung Il Kim, Jae Ho Cheong, Woo Jin Hyung, Sung Hoon Noh, Hyo Song Kim, Sun Young Rha, Hyun Cheol Chung

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30 Citations (Scopus)


Objective: The aim of this study was to evaluate the association between metformin and survival of gastric cancer (GC) patients. Background: Metformin has recently received attention as a potential anticancer treatment. However, no study has shown the survival benefit of metformin for GC patients. Methods: A total of 1974 GC patients who underwent curative gastrectomy were compared for survival according to groups; 132 diabetic patients treated with metformin, 194 diabetic patients without metformin, and 1648 nondiabetic patients. Results: During the median follow-up period of 6.2 years (interquartile range, 4.7-7.8 years), 381 patients (19.3%) died, including 302 (15.3%) who died from GC. The non-diabetic patients had significantly better recurrence-free survival (RFS; P<0.0001), cancer-specific survival (CSS; P=0.006), and overall survival (OS; P<0.0001). However, the diabetic patients treated with metformin had a significantly better prognosis than those who were not (OS: hazard ratio [HR]=0.584, 95% confidence interval [CI], 0.369-0.926; CSS: HR=0.57, 95% CI, 0.334-0.975; RFS: HR=0.633, 95% CI, 0.410-0.977), and metformin treatment prolonged survival in diabetic patients to a rate comparable to that in non-diabetic patients. In multivariable analysis using the Cox proportional hazard model with time-dependent covariates, each cumulative 6 months of metformin use was significantly associated with a decreased risk of recurrence, cancer-specific mortality, and all-cause mortality (RFS: HR=0.864, 95% CI, 0.797-0.937; CSS: HR=0.865, 95% CI, 0.782-0.958; OS: HR 0.870, 95% CI, 0.801-0.945). Conclusions: The increased cumulative duration of metformin use decreased the recurrence, all-cause mortality, and cancer-specific mortality rates among GC patients with diabetes who underwent gastrectomy.

Original languageEnglish
Pages (from-to)96-102
Number of pages7
JournalAnnals of surgery
Issue number1
Publication statusPublished - 2016

Bibliographical note

Funding Information:
This study was supported by a faculty research grant of the Department of Internal Medicine, Yonsei University College of Medicine, for 2012 (4–2012–0438).

All Science Journal Classification (ASJC) codes

  • Surgery

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