Effects of metformin on prognosis of type Ⅰ endometrial carcinoma patients complicated with type 2 diabetes mellitus / 国际肿瘤学杂志

ABSTRACT

Objective:To explore the effects of metformin on the prognosis of type Ⅰ endometrial carcinoma (EC) patients complicated with type 2 diabetes mellitus (T2DM).Methods:The clinical data of 45 type Ⅰ EC patients complicated with T2DM (T2DM group) and 147 type Ⅰ EC patients without diabetes mellitus (non-diabetes group) admitted to Qilu Hospital of Shandong University from January 2010 to December 2014 were retrospectively analyzed. The type Ⅰ EC patients with T2DM were divided into two groups, metformin group ( n=23, taking metformin to control blood glucose in normal range) and non-metformin group ( n=22, taking other hypoglycemic drugs or using insulin to control blood glucose in normal range). The clinicopathological characteristics of T2DM group and non-diabetes group were compared, and the effects of metformin on the prognosis of type Ⅰ EC patients with T2DM were analyzed. Results:Compared with non-diabetes group, the type Ⅰ EC patients in T2DM group have the older onset age ( t=4.331, P<0.001), more complicated with hypertension ( χ2=19.252, P<0.001), later surgical pathological stage ( χ2=4.588, P=0.032), higher histological grade ( χ2=6.069, P=0.048), deeper myometrial infiltration ( χ2=7.743, P=0.005) and higher incidence of lymph node metastasis ( χ2=4.885, P=0.027). The median progression-free survival (PFS) (47.0 months vs. 38.0 months) and median overall survival (OS) (52.0 months vs. 41.0 months) in metformin group were significantly longer than those in non-metformin group ( χ2=10.899, P=0.001; χ2=10.090, P=0.001). There was no significant difference in median PFS (47.0 months vs. 46.0 months) and median OS (52.0 months vs. 46.0 months) between metformin group and non-diabetes group ( χ2=0.791, P=0.374; χ2=0.836, P=0.360). Cox multivariate analysis showed that the risk factors of PFS and OS in type ⅠEC patients were old onset age( OR=2.128, 95% CI 1.361-3.328, P=0.001; OR=4.502, 95% CI 1.696-11.954, P=0.003), late surgical pathological stage( OR=2.231, 95% CI 1.437-3.462, P=0.001; OR=4.005, 95% CI 1.480-10.836, P=0.006), high histological grade( P=0.001; P=0.017; G2 vs.G1 OR=5.660, 95% CI 3.424-9.357, P=0.001; OR=5.763, 95% CI 1.666-19.938, P=0.006), deep myometrial invasion( OR=1.531, 95% CI 1.049-2.235, P=0.027; OR=3.759, 95% CI 1.890-7.476, P=0.001), positive lymph node metastasis ( OR=11.277, 95% CI 2.774-45.838, P=0.001; OR=8.451, 95% CI 1.138-62.767, P=0.037)and T2DM ( OR=1.897, 95% CI 1.096-3.281, P=0.008; OR=1.813, 95% CI 1.043-3.151, P=0.012). Metformin was the protective factor of PFS ( OR=0.412, 95% CI 0.207-0.818, P=0.002) and OS ( OR=0.455, 95% CI 0.228-0.905, P=0.008) in type Ⅰ EC patients with T2DM. Conclusion:Complication with T2DM is the negative factor on the prognosis of type Ⅰ EC patients. Intake of metformin can significantly improve the PFS and OS of type Ⅰ EC patients complicated with T2DM and improve the prognosis.