M Rieken1, E Xylinas2, L Kluth3, Q-D Trinh4, R K Lee5, H Fajkovic6, G Novara7, V Margulis8, Y Lotan8, J I Martinez-Salamanca9, K Matsumoto10, C Seitz6, M Remzi11, P I Karakiewicz12, D S Scherr5, A Briganti13, A Kautzky-Willer14, A Bachmann15, S F Shariat16. 1. Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA; Department of Urology, University Hospital Basel, Basel, Switzerland. 2. Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA; Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France. 3. Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 4. Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA. 5. Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA. 6. Department of Urology, Medical University of Vienna, Vienna, Austria. 7. Department of Surgical, Oncological and Gastroenterologic Sciences, Urology Clinic, University of Padua, Italy. 8. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA. 9. Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain. 10. Department of Urology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan. 11. Department of Urology, Landesklinikum Korneuburg, Korneuburg, Austria. 12. Department of Urology, University of Montreal, Montreal, QC, Canada. 13. Department of Urology, Vita-Salute University, Milan, Italy. 14. Unit of Gender Medicine, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria. 15. Department of Urology, University Hospital Basel, Basel, Switzerland. 16. Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA; Department of Urology, Medical University of Vienna, Vienna, Austria. Electronic address: sfshariat@gmail.com.
Abstract
AIMS: Evidence suggests a detrimental effect of diabetes mellitus (DM) on cancer incidence and outcomes. To date, the effect of DM and its treatment on prognosis in upper tract urothelial carcinoma (UTUC) remains uninvestigated. We tested the hypothesis that DM and metformin use impact oncologic outcomes of patients treated with radical nephroureterectomy (RNU) for UTUC. METHODS: Retrospective analysis of 2492 patients with UTUC treated at 23 institutions with RNU without neoadjuvant therapy. Cox regression models addressed the association of DM and metformin use with disease recurrence, cancer-specific mortality and any-cause mortality. RESULTS: A total of 365 (14.3%) patients had DM and 194 (7.8%) patients used metformin. Within a median follow-up of 36 months, 663 (26.6%) patients experienced disease recurrence, 545 patients (21.9%) died of UTUC and 884 (35.5%) patients died from any cause. Diabetic patients who did not use metformin were at significantly higher risk of disease recurrence and cancer-specific death compared to non-diabetic patients and diabetic patients who used metformin. In multivariable Cox regression analyses, DM treated without metformin was associated with worse recurrence-free survival (HR: 1.44, 95% CI 1.10-1.90, p = 0.009) and cancer-specific mortality (HR: 1.49, 95% CI 1.11-2.00, p = 0.008). CONCLUSIONS: Diabetic UTUC patients without metformin use have significantly worse oncologic outcomes than diabetics who used metformin and non-diabetics. The possible mechanism behind the impact of DM on UTUC biology and the potentially protective effect of metformin need further elucidation.
AIMS: Evidence suggests a detrimental effect of diabetes mellitus (DM) on cancer incidence and outcomes. To date, the effect of DM and its treatment on prognosis in upper tract urothelial carcinoma (UTUC) remains uninvestigated. We tested the hypothesis that DM and metformin use impact oncologic outcomes of patients treated with radical nephroureterectomy (RNU) for UTUC. METHODS: Retrospective analysis of 2492 patients with UTUC treated at 23 institutions with RNU without neoadjuvant therapy. Cox regression models addressed the association of DM and metformin use with disease recurrence, cancer-specific mortality and any-cause mortality. RESULTS: A total of 365 (14.3%) patients had DM and 194 (7.8%) patients used metformin. Within a median follow-up of 36 months, 663 (26.6%) patients experienced disease recurrence, 545 patients (21.9%) died of UTUC and 884 (35.5%) patients died from any cause. Diabeticpatients who did not use metformin were at significantly higher risk of disease recurrence and cancer-specific death compared to non-diabeticpatients and diabeticpatients who used metformin. In multivariable Cox regression analyses, DM treated without metformin was associated with worse recurrence-free survival (HR: 1.44, 95% CI 1.10-1.90, p = 0.009) and cancer-specific mortality (HR: 1.49, 95% CI 1.11-2.00, p = 0.008). CONCLUSIONS:Diabetic UTUCpatients without metformin use have significantly worse oncologic outcomes than diabetics who used metformin and non-diabetics. The possible mechanism behind the impact of DM on UTUC biology and the potentially protective effect of metformin need further elucidation.
Authors: Aurélie Mbeutcha; Morgan Rouprêt; Ashish M Kamat; Pierre I Karakiewicz; Nathan Lawrentschuk; Giacomo Novara; Jay D Raman; Christian Seitz; Evanguelos Xylinas; Shahrokh F Shariat Journal: World J Urol Date: 2016-04-21 Impact factor: 4.226
Authors: Eun Kyung Jang; Won Gu Kim; Hyemi Kwon; Yun Mi Choi; Min Ji Jeon; Tae Yong Kim; Young Kee Shong; Won Bae Kim; Eui Young Kim Journal: Eur Thyroid J Date: 2015-08-20
Authors: Aurélie Mbeutcha; Romain Mathieu; Morgan Rouprêt; Kilian M Gust; Alberto Briganti; Pierre I Karakiewicz; Shahrokh F Shariat Journal: Transl Androl Urol Date: 2016-10
Authors: Sung Gu Kang; Eu Chang Hwang; Seung Il Jung; Ho Song Yu; Ho Seok Chung; Taek Won Kang; Dong Deuk Kwon; Jun Eul Hwang; Jun Seok Kim; Joon Hwa Noh; Jae Hyung You; Myung Ki Kim; Tae Hoon Oh; Ill Young Seo; Seung Baik; Chul-Sung Kim; Seok Ho Kang; Jun Cheon Journal: Cancer Res Treat Date: 2016-03-23 Impact factor: 4.679