The association between metformin use and oncologic outcomes among surgically treated diabetic patients with localized renal cell carcinoma

Sarah P. Psutka, Stephen A. Boorjian, Christine M. Lohse, Suzanne B. Stewart, Matthew K. Tollefson, John C. Cheville, Bradley C. Leibovich, R. Houston Thompson

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Metformin inhibits renal cell carcinoma (RCC) cell proliferation both in vitro and in vivo; however, clinical data regarding the effect of metformin in patients with RCC are lacking. We evaluated the association of metformin use with outcomes among patients with surgically treated localized RCC. Materials and methods: We identified 283 consecutive diabetic patients treated surgically for localized RCC between January 1, 1994 and December 31, 2008. Clinicopathologic features were compared between patients exposed to metformin (n = 83, 29%) and those who were not (n = 200, 71%). Progression-free, cancer-specific, and overall survival rates were estimated with the Kaplan-Meier analysis, and Cox models were used to evaluate the association of metformin use with outcomes. Results and conclusions: Patients receiving metformin had a better renal function (median estimated glomerular filtration rate = 65 vs. 55ml/min/1.73m2, P<0.001), performance status (Eastern Cooperative Oncology Group<1: 89% vs. 71%, P = 0.001), and lower Charlson comorbidity index (median = 2 vs. 3, P = 0.02) compared with those who did not, but were otherwise similar across other clinicopathologic features (P>0.05 for all). At a median postoperative follow-up of 8.1 years, patients exposed to metformin had similar 5-year progression-free (80% vs. 75%, P = 0.6) and cancer-specific survival rates (91% vs. 81%, P = 0.16), but significantly improved overall survival rate (79% vs. 62%, P = 0.01). However, metformin was not independently associated with the risks of progression, RCC-specific mortality, or all-cause mortality on multivariable analyses. In this surgical cohort of diabetic patients with M0 RCC, preoperative metformin exposure was associated with improved overall survival on unadjusted analysis. Although metformin was not independently associated with oncologic or survival outcomes, future studies appear warranted.

Original languageEnglish (US)
Pages (from-to)67e15-67e23
JournalUrologic Oncology: Seminars and Original Investigations
Volume33
Issue number2
DOIs
StatePublished - Feb 1 2015

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Metformin
Renal Cell Carcinoma
Survival Rate
Survival
Mortality
Kaplan-Meier Estimate
Glomerular Filtration Rate
Proportional Hazards Models
Neoplasms
Cell Proliferation
Kidney

Keywords

  • Diabetes
  • Metformin
  • Mortality
  • Recurrence
  • Renal cell carcinoma

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

The association between metformin use and oncologic outcomes among surgically treated diabetic patients with localized renal cell carcinoma. / Psutka, Sarah P.; Boorjian, Stephen A.; Lohse, Christine M.; Stewart, Suzanne B.; Tollefson, Matthew K.; Cheville, John C.; Leibovich, Bradley C.; Thompson, R. Houston.

In: Urologic Oncology: Seminars and Original Investigations, Vol. 33, No. 2, 01.02.2015, p. 67e15-67e23.

Research output: Contribution to journalArticle

Psutka, Sarah P. ; Boorjian, Stephen A. ; Lohse, Christine M. ; Stewart, Suzanne B. ; Tollefson, Matthew K. ; Cheville, John C. ; Leibovich, Bradley C. ; Thompson, R. Houston. / The association between metformin use and oncologic outcomes among surgically treated diabetic patients with localized renal cell carcinoma. In: Urologic Oncology: Seminars and Original Investigations. 2015 ; Vol. 33, No. 2. pp. 67e15-67e23.
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abstract = "Metformin inhibits renal cell carcinoma (RCC) cell proliferation both in vitro and in vivo; however, clinical data regarding the effect of metformin in patients with RCC are lacking. We evaluated the association of metformin use with outcomes among patients with surgically treated localized RCC. Materials and methods: We identified 283 consecutive diabetic patients treated surgically for localized RCC between January 1, 1994 and December 31, 2008. Clinicopathologic features were compared between patients exposed to metformin (n = 83, 29{\%}) and those who were not (n = 200, 71{\%}). Progression-free, cancer-specific, and overall survival rates were estimated with the Kaplan-Meier analysis, and Cox models were used to evaluate the association of metformin use with outcomes. Results and conclusions: Patients receiving metformin had a better renal function (median estimated glomerular filtration rate = 65 vs. 55ml/min/1.73m2, P<0.001), performance status (Eastern Cooperative Oncology Group<1: 89{\%} vs. 71{\%}, P = 0.001), and lower Charlson comorbidity index (median = 2 vs. 3, P = 0.02) compared with those who did not, but were otherwise similar across other clinicopathologic features (P>0.05 for all). At a median postoperative follow-up of 8.1 years, patients exposed to metformin had similar 5-year progression-free (80{\%} vs. 75{\%}, P = 0.6) and cancer-specific survival rates (91{\%} vs. 81{\%}, P = 0.16), but significantly improved overall survival rate (79{\%} vs. 62{\%}, P = 0.01). However, metformin was not independently associated with the risks of progression, RCC-specific mortality, or all-cause mortality on multivariable analyses. In this surgical cohort of diabetic patients with M0 RCC, preoperative metformin exposure was associated with improved overall survival on unadjusted analysis. Although metformin was not independently associated with oncologic or survival outcomes, future studies appear warranted.",
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AU - Lohse, Christine M.

AU - Stewart, Suzanne B.

AU - Tollefson, Matthew K.

AU - Cheville, John C.

AU - Leibovich, Bradley C.

AU - Thompson, R. Houston

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N2 - Metformin inhibits renal cell carcinoma (RCC) cell proliferation both in vitro and in vivo; however, clinical data regarding the effect of metformin in patients with RCC are lacking. We evaluated the association of metformin use with outcomes among patients with surgically treated localized RCC. Materials and methods: We identified 283 consecutive diabetic patients treated surgically for localized RCC between January 1, 1994 and December 31, 2008. Clinicopathologic features were compared between patients exposed to metformin (n = 83, 29%) and those who were not (n = 200, 71%). Progression-free, cancer-specific, and overall survival rates were estimated with the Kaplan-Meier analysis, and Cox models were used to evaluate the association of metformin use with outcomes. Results and conclusions: Patients receiving metformin had a better renal function (median estimated glomerular filtration rate = 65 vs. 55ml/min/1.73m2, P<0.001), performance status (Eastern Cooperative Oncology Group<1: 89% vs. 71%, P = 0.001), and lower Charlson comorbidity index (median = 2 vs. 3, P = 0.02) compared with those who did not, but were otherwise similar across other clinicopathologic features (P>0.05 for all). At a median postoperative follow-up of 8.1 years, patients exposed to metformin had similar 5-year progression-free (80% vs. 75%, P = 0.6) and cancer-specific survival rates (91% vs. 81%, P = 0.16), but significantly improved overall survival rate (79% vs. 62%, P = 0.01). However, metformin was not independently associated with the risks of progression, RCC-specific mortality, or all-cause mortality on multivariable analyses. In this surgical cohort of diabetic patients with M0 RCC, preoperative metformin exposure was associated with improved overall survival on unadjusted analysis. Although metformin was not independently associated with oncologic or survival outcomes, future studies appear warranted.

AB - Metformin inhibits renal cell carcinoma (RCC) cell proliferation both in vitro and in vivo; however, clinical data regarding the effect of metformin in patients with RCC are lacking. We evaluated the association of metformin use with outcomes among patients with surgically treated localized RCC. Materials and methods: We identified 283 consecutive diabetic patients treated surgically for localized RCC between January 1, 1994 and December 31, 2008. Clinicopathologic features were compared between patients exposed to metformin (n = 83, 29%) and those who were not (n = 200, 71%). Progression-free, cancer-specific, and overall survival rates were estimated with the Kaplan-Meier analysis, and Cox models were used to evaluate the association of metformin use with outcomes. Results and conclusions: Patients receiving metformin had a better renal function (median estimated glomerular filtration rate = 65 vs. 55ml/min/1.73m2, P<0.001), performance status (Eastern Cooperative Oncology Group<1: 89% vs. 71%, P = 0.001), and lower Charlson comorbidity index (median = 2 vs. 3, P = 0.02) compared with those who did not, but were otherwise similar across other clinicopathologic features (P>0.05 for all). At a median postoperative follow-up of 8.1 years, patients exposed to metformin had similar 5-year progression-free (80% vs. 75%, P = 0.6) and cancer-specific survival rates (91% vs. 81%, P = 0.16), but significantly improved overall survival rate (79% vs. 62%, P = 0.01). However, metformin was not independently associated with the risks of progression, RCC-specific mortality, or all-cause mortality on multivariable analyses. In this surgical cohort of diabetic patients with M0 RCC, preoperative metformin exposure was associated with improved overall survival on unadjusted analysis. Although metformin was not independently associated with oncologic or survival outcomes, future studies appear warranted.

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