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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 
 ANNALS OF SURGERY, Vol.263(1) : 96-102, 2016 
Journal Title
Issue Date
Adult ; Aged ; Aged, 80 and over ; Cohort Studies ; Diabetes Complications/complications ; Diabetes Complications/drug therapy* ; Female ; Gastrectomy* ; Humans ; Hypoglycemic Agents/therapeutic use* ; Male ; Metformin/therapeutic use* ; Middle Aged ; Retrospective Studies ; Stomach Neoplasms/complications ; Stomach Neoplasms/mortality* ; Stomach Neoplasms/surgery* ; Survival Rate ; Young Adult
diabetes mellitus ; gastric cancer ; metformin ; survival benefit
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 non-diabetic 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.
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1. College of Medicine (의과대학) > Dept. of Biomedical Systems Informatics (의생명시스템정보학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Hyoung Il(김형일) ORCID logo https://orcid.org/0000-0002-6134-4523
Kim, Hyo Song(김효송) ORCID logo https://orcid.org/0000-0002-0625-9828
Noh, Sung Hoon(노성훈) ORCID logo https://orcid.org/0000-0003-4386-6886
Rha, Sun Young(라선영) ORCID logo https://orcid.org/0000-0002-2512-4531
An, Ji Yeong(안지영)
Lee, Choong-kun(이충근) ORCID logo https://orcid.org/0000-0001-5151-5096
Jung, Min Kyu(정민규) ORCID logo https://orcid.org/0000-0001-8281-3387
Jeong, Yong Hyu(정용휴) ORCID logo https://orcid.org/0000-0002-0198-0026
Jung, Inkyung(정인경) ORCID logo https://orcid.org/0000-0003-3780-3213
Cheong, Jae Ho(정재호) ORCID logo https://orcid.org/0000-0002-1703-1781
Chung, Hyun Cheol(정현철) ORCID logo https://orcid.org/0000-0002-0920-9471
Heo, Su Jin(허수진) ORCID logo https://orcid.org/0000-0002-0615-5869
Hyung, Woo Jin(형우진) ORCID logo https://orcid.org/0000-0002-8593-9214
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