Metformin and endometrial cancer survival: a quantitative synthesis of observational studies
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Jianfeng Guo1,*, Kai Xu2,*, Min An4 and Yingchao Zhao3
1Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
2Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
3Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
4ZhuJiang Hospital, Southern Medical University, Guangzhou 510515, China
*These authors have contributed equally to this work
Yingchao Zhao, email: [email protected]
Keywords: metformin, endometrial cancer, survival, quantitative synthesis, observational study
Received: May 30, 2017 Accepted: June 28, 2017 Published: August 02, 2017
Metformin has been reported to have anticancer effect and can affect patient survival in several malignancies. However, the results are inconclusive for endometrial cancer. Hence, we conducted a systematic review and meta-analysis to investigate the prognostic role of metformin in patients with endometrial cancer. Studies were identified from Pubmed and Embase database through March 2017. Observational studies reporting hazard ratios (HRs) with 95% confidence intervals (CIs) for overall survival (OS) and progression-free survival (PFS) were selected. Data were abstracted and summarised using random-effects models. From 250 unique citations, we identified ten studies including 6242 patients with nine studies examining OS and five studies examining PFS. Meta-analysis demonstrated that metformin users had better OS (HR, 0.58; 95% CI, 0.45 to 0.76; P = 0.207, I2 = 26.6%) and PFS (HR, 0.61; 95% CI, 0.49 to 0.76; P =0.768, I2 = 0%) than non-users for endometrial cancer patients. Similar findings were observed using sensitivity analysis adjusted by trim and filled methods (HR, 0.47; 95% CI, 0.37 to 0.58) and subgroup analyses. Based on the current evidence, we find that metformin use is associated with better OS and PFS in patients with endometrial cancer. However, further large-scale prospective studies are needed to establish its validity.
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