Diabetes, metformin use, and survival in esophageal cancer : a population-based cohort study
Wang, Qiao-Li LU
; Santoni, Giola
and Lagergren, Jesper
(2023)
In JNCI Cancer Spectrum
7(4).
- Abstract
BACKGROUND: It is unclear how diabetes and metformin use is associated with survival of esophageal cancer.
METHODS: This population-based cohort study included new cases of esophageal cancer reported in Sweden from 2006 to 2018 with follow-up through 2019. Diabetes status and metformin use were analyzed in relation to all-cause and disease-specific mortality using multivariable Cox regression. The hazard ratios (HRs) with 95% confidence intervals (CIs) were adjusted for age, sex, calendar year, obesity, comorbidity, and use of nonsteroidal anti-inflammatory drugs or statins. For comparison reasons, 3 other antidiabetic medications were also analyzed (ie, sulfonylureas, insulin, and thiazolidinedione).
RESULTS: Among 4851... (More)
BACKGROUND: It is unclear how diabetes and metformin use is associated with survival of esophageal cancer.
METHODS: This population-based cohort study included new cases of esophageal cancer reported in Sweden from 2006 to 2018 with follow-up through 2019. Diabetes status and metformin use were analyzed in relation to all-cause and disease-specific mortality using multivariable Cox regression. The hazard ratios (HRs) with 95% confidence intervals (CIs) were adjusted for age, sex, calendar year, obesity, comorbidity, and use of nonsteroidal anti-inflammatory drugs or statins. For comparison reasons, 3 other antidiabetic medications were also analyzed (ie, sulfonylureas, insulin, and thiazolidinedione).
RESULTS: Among 4851 esophageal cancer patients (8404 person-years), 4072 (84%) died during follow-up. Compared with esophageal cancer patients with diabetes but not using metformin, decreased all-cause mortality was indicated among nondiabetic patients (without metformin) (HR = 0.86, 95% CI = 0.77 to 0.96) and diabetic patients who used metformin (HR = 0.86, 95% CI = 0.75 to 1.00). The hazard ratios of all-cause mortality decreased with a higher daily dose of metformin (Ptrend = .04). The corresponding hazard ratios for disease-specific mortality were similar but slightly attenuated. The results were also similar in separate analyses of esophageal cancer patients with adenocarcinoma or squamous cell carcinoma, with tumor stage I-II or III-IV, and in those who had or had not undergone surgery. No associations with mortality outcomes were found for use of sulfonylureas, insulin, or thiazolidinedione.
CONCLUSIONS: Diabetes was associated with an increased all-cause mortality, whereas metformin use was associated with decreased all-cause mortality among esophageal cancer patients. More research is needed to determine if metformin affects survival in esophageal cancer.
(Less)
- author
- Wang, Qiao-Li
LU
; Santoni, Giola
and Lagergren, Jesper
- publishing date
- 2023-07-03
- type
- Contribution to journal
- publication status
- published
- keywords
- Humans, Metformin/therapeutic use, Cohort Studies, Risk Factors, Diabetes Mellitus, Esophageal Neoplasms, Sulfonylurea Compounds/therapeutic use, Insulins/therapeutic use
- in
- JNCI Cancer Spectrum
- volume
- 7
- issue
- 4
- article number
- pkad043
- publisher
- Oxford University Press
- external identifiers
-
- scopus:85165189971
- pmid:37314979
- ISSN
- 2515-5091
- DOI
- 10.1093/jncics/pkad043
- language
- English
- LU publication?
- no
- additional info
- © The Author(s) 2023. Published by Oxford University Press.
- id
- 4c76290a-f26d-48a3-b3a5-52067a3805e6
- date added to LUP
- 2025-05-12 17:08:07
- date last changed
- 2025-06-24 07:47:34
@article{4c76290a-f26d-48a3-b3a5-52067a3805e6,
abstract = {{<p>BACKGROUND: It is unclear how diabetes and metformin use is associated with survival of esophageal cancer.</p><p>METHODS: This population-based cohort study included new cases of esophageal cancer reported in Sweden from 2006 to 2018 with follow-up through 2019. Diabetes status and metformin use were analyzed in relation to all-cause and disease-specific mortality using multivariable Cox regression. The hazard ratios (HRs) with 95% confidence intervals (CIs) were adjusted for age, sex, calendar year, obesity, comorbidity, and use of nonsteroidal anti-inflammatory drugs or statins. For comparison reasons, 3 other antidiabetic medications were also analyzed (ie, sulfonylureas, insulin, and thiazolidinedione).</p><p>RESULTS: Among 4851 esophageal cancer patients (8404 person-years), 4072 (84%) died during follow-up. Compared with esophageal cancer patients with diabetes but not using metformin, decreased all-cause mortality was indicated among nondiabetic patients (without metformin) (HR = 0.86, 95% CI = 0.77 to 0.96) and diabetic patients who used metformin (HR = 0.86, 95% CI = 0.75 to 1.00). The hazard ratios of all-cause mortality decreased with a higher daily dose of metformin (Ptrend = .04). The corresponding hazard ratios for disease-specific mortality were similar but slightly attenuated. The results were also similar in separate analyses of esophageal cancer patients with adenocarcinoma or squamous cell carcinoma, with tumor stage I-II or III-IV, and in those who had or had not undergone surgery. No associations with mortality outcomes were found for use of sulfonylureas, insulin, or thiazolidinedione.</p><p>CONCLUSIONS: Diabetes was associated with an increased all-cause mortality, whereas metformin use was associated with decreased all-cause mortality among esophageal cancer patients. More research is needed to determine if metformin affects survival in esophageal cancer.</p>}},
author = {{Wang, Qiao-Li and Santoni, Giola and Lagergren, Jesper}},
issn = {{2515-5091}},
keywords = {{Humans; Metformin/therapeutic use; Cohort Studies; Risk Factors; Diabetes Mellitus; Esophageal Neoplasms; Sulfonylurea Compounds/therapeutic use; Insulins/therapeutic use}},
language = {{eng}},
month = {{07}},
number = {{4}},
publisher = {{Oxford University Press}},
series = {{JNCI Cancer Spectrum}},
title = {{Diabetes, metformin use, and survival in esophageal cancer : a population-based cohort study}},
url = {{http://dx.doi.org/10.1093/jncics/pkad043}},
doi = {{10.1093/jncics/pkad043}},
volume = {{7}},
year = {{2023}},
}