Daniel E Spratt1, Beth M Beadle2, Zachary S Zumsteg3,1, Andrew Rivera1, Heath D Skinner4, Joseph R Osborne5, Adam S Garden2, Nancy Y Lee1. 1. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY. 2. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 3. Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles CA. 4. Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas. 5. Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
Abstract
PURPOSE: Local control in oropharyngeal cancer has improved to unprecedented rates with combined modality therapy; as a result, distant metastases are becoming a principal challenge. We aimed to determine the impact of diabetes mellitus and metformin use on clinical outcomes in a large population of oropharyngeal cancer patients treated in the modern era. METHODS AND MATERIALS: We identified 1745 consecutive patients with oropharyngeal cancer treated at 2 large cancer centers with external beam radiation therapy from 1998 to 2011. A total of 184 patients had diabetes mellitus at the time of diagnosis, of whom 102 were taking metformin. The outcomes assessed included local failure-free survival (LFFS), regional failure-free survival (RFFS), distant metastasis-free survival (DMFS), and overall survival (OS). RESULTS: The median follow-up time was 4.3 years. The 5-year actuarial rates of DMFS were 89.6% for nondiabetic patients and 78.7% for diabetic nonmetformin users (P=.011) and of OS were 83.0% for nondiabetic patients and 70.7% for diabetic nonmetformin users (P=.048). Diabetic metformin users had 5-year DMFS (90.1%) and OS (89.6%) similar to those of nondiabetic patients. Multivariate analysis (diabetic nonmetformin users as reference) demonstrated improved DMFS for nondiabetic patients (adjusted hazard ratio 0.54; 95% confidence interval 0.32-0.93; P=.03) and a trend toward improved DMFS with metformin use (adjusted hazard ratio 0.46; 95% confidence interval 0.20-1.04; P=.06). LFFS and RFFS were high in all groups and were not significantly different by diabetic status or metformin use. CONCLUSIONS: Diabetic patients not using metformin independently have significantly higher rates of distant metastases than do nondiabetic patients, whereas metformin users have rates of distant metastases similar to those of nondiabetic patients. Further prospective investigation is warranted to validate the benefit of metformin in oropharyngeal cancer.
PURPOSE: Local control in oropharyngeal cancer has improved to unprecedented rates with combined modality therapy; as a result, distant metastases are becoming a principal challenge. We aimed to determine the impact of diabetes mellitus and metformin use on clinical outcomes in a large population of oropharyngeal cancerpatients treated in the modern era. METHODS AND MATERIALS: We identified 1745 consecutive patients with oropharyngeal cancer treated at 2 large cancer centers with external beam radiation therapy from 1998 to 2011. A total of 184 patients had diabetes mellitus at the time of diagnosis, of whom 102 were taking metformin. The outcomes assessed included local failure-free survival (LFFS), regional failure-free survival (RFFS), distant metastasis-free survival (DMFS), and overall survival (OS). RESULTS: The median follow-up time was 4.3 years. The 5-year actuarial rates of DMFS were 89.6% for nondiabeticpatients and 78.7% for diabetic nonmetformin users (P=.011) and of OS were 83.0% for nondiabeticpatients and 70.7% for diabetic nonmetformin users (P=.048). Diabeticmetformin users had 5-year DMFS (90.1%) and OS (89.6%) similar to those of nondiabeticpatients. Multivariate analysis (diabetic nonmetformin users as reference) demonstrated improved DMFS for nondiabeticpatients (adjusted hazard ratio 0.54; 95% confidence interval 0.32-0.93; P=.03) and a trend toward improved DMFS with metformin use (adjusted hazard ratio 0.46; 95% confidence interval 0.20-1.04; P=.06). LFFS and RFFS were high in all groups and were not significantly different by diabetic status or metformin use. CONCLUSIONS:Diabeticpatients not using metformin independently have significantly higher rates of distant metastases than do nondiabeticpatients, whereas metformin users have rates of distant metastases similar to those of nondiabeticpatients. Further prospective investigation is warranted to validate the benefit of metformin in oropharyngeal cancer.
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