Audrius Dulskas1, Ausvydas Patasius2, Donata Linkeviciute-Ulinskiene3, Lina Zabuliene4, Vincas Urbonas5, Giedre Smailyte2. 1. Department of Abdominal and General Surgery and Oncology, National Cancer Institute, 1 Santariskiu Str., Vilnius LT-08406, Lithuania; University of Applied Sciences, Faculty of Health Care, 45 Didlaukio Str., LT-08303 Vilnius, Lithuania; Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 1 Santariskiu Str., Vilnius LT-08406, Lithuania. Electronic address: Audrius.Dulskas@NVI.lt. 2. Laboratory of Cancer Epidemiology, National Cancer Institute, LT-08406 Vilnius, Lithuania; Institute of Health Sciences, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania. 3. Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania. 4. Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 1 Santariskiu Str., Vilnius LT-08406, Lithuania. 5. Laboratory of Clinical Oncology, Department of Medical Oncology, National Cancer Institute, Lithuania.
Abstract
PURPOSE: We aimed to assess oncological outcomes in colorectal cancer patients with type 2 diabetes mellitus (T2DM) using metformin. METHODS: Patients with colorectal cancer and T2DM during 2000-2012 period were identified form Lithuanian Cancer Registry and the National Health Insurance Fund database. Colorectal cancer-specific survival (CS) was the primary outcome. It was measured from date of colorectal cancer diagnosis to date of death due to colorectal cancer, or last known date alive. RESULTS: 15,052 people who met eligibility criteria for this analysis, including 1094 (7.27%) with pre-existing type 2 diabetes (271 metformin never users and 823 metformin users) and 13 958 people without diabetes assessed. During follow-up (mean follow-up time was 4.4 years, with range from 1 day to 17 years) there were 10,927 deaths including 8559 from colorectal cancer. Significantly lower risk in CS between diabetic and non-diabetic people with lower risk of cancer-specific mortality (HR 0.87, 95% CI 0.80-0.94) in diabetic patient population was seen. After adjustment for age, stage at diagnosis and metformin usage, significant difference in colorectal CS between metformin users in diabetic patient population compared to non-diabetics and metformin non-users in diabetic patient population was found (0.80 (0.72-0.89) vs 1.00 and vs 1.05 (0.91-1.23)). Overall survival (OS) was better for diabetic patients with significant difference in diabetic metformin users (HR 0.91, 95% CI 0.79-0.94). CONCLUSIONS: Colorectal cancer patients with T2DM treated with metformin as part of their diabetic therapy appear to have a superior OS and CS. However, prospective controlled studies are still needed to evaluate the efficacy of metformin as an anti-tumor agent.
PURPOSE: We aimed to assess oncological outcomes in colorectal cancerpatients with type 2 diabetes mellitus (T2DM) using metformin. METHODS:Patients with colorectal cancer and T2DM during 2000-2012 period were identified form Lithuanian Cancer Registry and the National Health Insurance Fund database. Colorectal cancer-specific survival (CS) was the primary outcome. It was measured from date of colorectal cancer diagnosis to date of death due to colorectal cancer, or last known date alive. RESULTS: 15,052 people who met eligibility criteria for this analysis, including 1094 (7.27%) with pre-existing type 2 diabetes (271 metformin never users and 823 metformin users) and 13 958 people without diabetes assessed. During follow-up (mean follow-up time was 4.4 years, with range from 1 day to 17 years) there were 10,927 deaths including 8559 from colorectal cancer. Significantly lower risk in CS between diabetic and non-diabeticpeople with lower risk of cancer-specific mortality (HR 0.87, 95% CI 0.80-0.94) in diabeticpatient population was seen. After adjustment for age, stage at diagnosis and metformin usage, significant difference in colorectal CS between metformin users in diabeticpatient population compared to non-diabetics and metformin non-users in diabeticpatient population was found (0.80 (0.72-0.89) vs 1.00 and vs 1.05 (0.91-1.23)). Overall survival (OS) was better for diabeticpatients with significant difference in diabeticmetformin users (HR 0.91, 95% CI 0.79-0.94). CONCLUSIONS:Colorectal cancerpatients with T2DM treated with metformin as part of their diabetic therapy appear to have a superior OS and CS. However, prospective controlled studies are still needed to evaluate the efficacy of metformin as an anti-tumor agent.
Authors: Audrius Dulskas; Ausvydas Patasius; Donata Linkeviciute-Ulinskiene; Lina Zabuliene; Giedre Smailyte Journal: Int J Environ Res Public Health Date: 2020-08-19 Impact factor: 3.390
Authors: Povilas Kavaliauskas; Audrius Dulskas; Inga Kildusiene; Rokas Arlauskas; Rimantas Stukas; Giedre Smailyte Journal: Int J Environ Res Public Health Date: 2022-01-15 Impact factor: 3.390