title: Can metformin improve 'the tomorrow' of patients treated for oesophageal cancer?
abstract: BACKGROUND
  Recent studies suggest that the use of metformin is associated with reduced cancer incidence and improved prognosis in patients with oesophageal cancer. We explored the relationship between the use of metformin and outcome (pathologic response rate, distant metastasis-free and overall survival) in our mono-institutional cohort of patients treated for oesophageal cancer.
  
  
  METHODS
  Between 2008 and 2014, a total of 196 patients with oesophageal cancer (ages ranged from 37 to 82 years) eligible for curative treatment entered the study. Patients were categorized as non-diabetic (n = 172), diabetic not taking metformin (n = 5) or diabetic taking metformin (n = 19). The majority of patients were treated with trimodality therapy (n = 189). Pathologic response was graded according to Mandard's tumour regression score at the time of surgery. Distant metastasis-free and overall survival were calculated using the Kaplan-Meier method with log rank comparisons performed to determine significance.
  
  
  RESULTS
  The overall pathologic complete response rate for the study population was 26%. It was 25% for patients not using metformin and 39% for diabetics taking metformin (p = 0.260). The two-year overall survival rate for the whole group was 59%. Use of metformin was associated with a significantly better distant metastasis-free survival rate (p = 0.040) or overall survival rate (p = 0.012). Multivariate analysis using Cox regression found that metformin treatment significantly prolonged survival (p = 0.043).
  
  
  CONCLUSIONS
  In our population-based study, the use of metformin was associated with an improved overall and distant metastasis-free survival rate in patients with oesophageal cancer. These data are complementary to one other clinical study and warrant further prospective study.
authors.affiliation: Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre +, Maastricht, The Netherlands. Electronic address: Lien.vandevoorde@maastro.nl.
authors.forename: L
authors.initials: L
authors.lastname: Van De Voorde
authors.affiliation: Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre +, Maastricht, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: Janssen
authors.affiliation: Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre +, Maastricht, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Larue
authors.affiliation: Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre +, Maastricht, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Houben
authors.affiliation: Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre +, Maastricht, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Buijsen
authors.affiliation: Department of Surgery, Atrium Medical Center, Heerlen, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Sosef
authors.affiliation: Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre +, Maastricht, The Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: Vanneste
authors.affiliation: Department of Surgery, Atrium Medical Center, Heerlen, The Netherlands.
authors.forename: M-C
authors.initials: MC
authors.lastname: Schraepen
authors.affiliation: Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre +, Maastricht, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Berbée
authors.affiliation: Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre +, Maastricht, The Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Lambin
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016022:Case-Control Studies; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000008:administration & dosage; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D004938:Esophageal Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008687:Metformin / Q000627:therapeutic use*; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D017239:Paclitaxel / Q000008:administration & dosage; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin; D016190:Carboplatin; D017239:Paclitaxel; D002945:Cisplatin; D005472:Fluorouracil
keywords: Diabetes; Metformin; Oesophageal cancer; Survival