title: Metformin use and endometrial cancer survival.
abstract: OBJECTIVE
  Impaired glucose tolerance and diabetes are risk factors for the development of uterine cancer. Although greater progression free survival among diabetic patients with ovarian and breast cancers using metformin has been reported, no studies have assessed the association of metformin use with survival in women with endometrial cancer (EC).
  
  
  METHODS
  We conducted a single-institution retrospective cohort study of all patients treated for uterine cancer from January 1999 through December 2009. Demographic, medical, social, and survival data were abstracted from medical records and the national death registry. Overall survival (OS) was estimated using Kaplan-Meier methods. Cox models were utilized for multivariate analysis. All statistical tests were two-sided.
  
  
  RESULTS
  Of 985 patients, 114 (12%) had diabetes and were treated with metformin, 136 (14%) were diabetic but did not use metformin, and 735 (74%) had not been diagnosed with diabetes. Greater OS was observed in diabetics with non-endometrioid EC who used metformin than in diabetic cases not using metformin and non-endometrioid EC cases without diabetes (log rank test (p=0.02)). This association remained significant (hazard ratio=0.54, 95% CI: 0.30-0.97, p<0.04) after adjusting for age, clinical stage, grade, chemotherapy treatment, radiation treatment and the presence of hyperlipidemia in multivariate analysis. No association between metformin use and OS in diabetics with endometrioid histology was observed.
  
  
  CONCLUSIONS
  Diabetic EC patients with non-endometrioid tumors who used metformin had lower risk of death than women with EC who did not use metformin. These data suggest that metformin might be useful as adjuvant therapy for non-endometrioid EC.
authors.affiliation: Montefiore Medical Center, Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Bronx, NY, USA. Electronic address: nnevadun@montefiore.org.
authors.forename: Nicole S
authors.initials: NS
authors.lastname: Nevadunsky
authors.affiliation: Montefiore Medical Center, Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Bronx, NY, USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Van Arsdale
authors.affiliation: Albert Einstein Cancer Center, Albert Einstein College of Medicine, Bronx, NY, USA; Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, NY, USA.
authors.forename: Howard D
authors.initials: HD
authors.lastname: Strickler
authors.affiliation: Albert Einstein College of Medicine, Department of Epidemiology and Population Health, Bronx, NY, USA.
authors.forename: Alyson
authors.initials: A
authors.lastname: Moadel
authors.affiliation: Montefiore Medical Center, Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Bronx, NY, USA.
authors.forename: Gurpreet
authors.initials: G
authors.lastname: Kaur
authors.affiliation: Montefiore Medical Center, Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Bronx, NY, USA.
authors.forename: Marina
authors.initials: M
authors.lastname: Frimer
authors.affiliation: Montefiore Medical Center, Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Bronx, NY, USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Conroy
authors.affiliation: Montefiore Medical Center, Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Bronx, NY, USA; Albert Einstein Cancer Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Gary L
authors.initials: GL
authors.lastname: Goldberg
authors.affiliation: Montefiore Medical Center, Division of Gynecologic Oncology, Department of Obstetrics & Gynecology and Women's Health, Bronx, NY, USA; Albert Einstein Cancer Center, Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Einstein
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000188:drug therapy*; D016889:Endometrial Neoplasms / Q000401:mortality*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008687:Metformin / Q000627:therapeutic use*; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin
keywords: Adjuvant therapy; EC; Endometrial cancer; MMC; Metformin; Montefiore Medical Center; Non-endometrioid; OS; Retrospective cohort study; endometrial cancer; overall survival