title: Metformin and Not Diabetes Influences the Survival of Resected Early Stage NSCLC Patients.
abstract: BACKGROUND
  Published data suggest that diabetes influences survival of patients with lung cancer. The anti-cancer effect of metformin confounds this association. We sought to study the association of diabetes and metformin with survival in patients undergoing resection of stage I non-small cell lung cancer (NSCLC).
  
  
  METHODS
  Pathologic stage I NSCLC patients undergoing anatomic resection from 2002 to 2011 were studied. A diagnosis of diabetes and diabetic medication use were identified through records. Univariate and multivariate analyses examined the association of diabetes and metformin usage with overall survival (OS).
  
  
  RESULTS
  409 eligible patients were included in the analysis - excluding patients with neoadjuvant therapy, more than one lung cancer, or resection less than lobectomy. 71 (17.4%) patients were diabetics and 41 (10.0%) used metformin. With a median follow up of 44 months, univariate analysis demonstrates that diabetes had no effect on OS (P=0.75); however, metformin use was associated with improved OS (median survival not reached vs. 60 months; P=0.02). Metformin use remained an important predictor of good survival in multivariate analysis (HR=3.08; P<0.01) after adjusting for age, gender, pathologic stage, histology and smoking status.
  
  
  CONCLUSIONS
  Metformin use rather than diabetes is associated with improved long-term survival in Stage I NSCLC patients.
authors.affiliation: Department of Medicine-Thoracic Oncology/Pulmonary Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Samjot Singh
authors.initials: SS
authors.lastname: Dhillon
authors.affiliation: Department of Biostatistics and Bioinformatics, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Adrienne
authors.initials: A
authors.lastname: Groman
authors.affiliation: Department of Pharmacy, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Alison
authors.initials: A
authors.lastname: Meagher
authors.affiliation: Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Todd
authors.initials: T
authors.lastname: Demmy
authors.affiliation: Department of Radiation Oncology and Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Graham W
authors.initials: GW
authors.lastname: Warren
authors.affiliation: Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Sai
authors.initials: S
authors.lastname: Yendamuri
keywords: Diabetes Mellitus; Lung cancer; Metformin; Survival