title: The Influence of Diabetes Mellitus and Metformin on Distant Metastases in Oropharyngeal Cancer: A Multicenter Study.
abstract: OBJECTIVE
  Local control in oropharyngeal cancer has improved to unprecedented rates with combined modality therapy; as a result, distant metastases are becoming a principal challenge. We aimed to determine the impact of diabetes mellitus and metformin use on clinical outcomes in a large population of oropharyngeal cancer patients treated in the modern era.
  
  
  METHODS
  We identified 1745 consecutive patients with oropharyngeal cancer treated at 2 large cancer centers with external beam radiation therapy from 1998 to 2011. A total of 184 patients had diabetes mellitus at the time of diagnosis, of whom 102 were taking metformin. The outcomes assessed included local failure-free survival (LFFS), regional failure-free survival (RFFS), distant metastasis-free survival (DMFS), and overall survival (OS).
  
  
  RESULTS
  The median follow-up time was 4.3 years. The 5-year actuarial rates of DMFS were 89.6% for nondiabetic patients and 78.7% for diabetic nonmetformin users (P=.011) and of OS were 83.0% for nondiabetic patients and 70.7% for diabetic nonmetformin users (P=.048). Diabetic metformin users had 5-year DMFS (90.1%) and OS (89.6%) similar to those of nondiabetic patients. Multivariate analysis (diabetic nonmetformin users as reference) demonstrated improved DMFS for nondiabetic patients (adjusted hazard ratio 0.54; 95% confidence interval 0.32-0.93; P=.03) and a trend toward improved DMFS with metformin use (adjusted hazard ratio 0.46; 95% confidence interval 0.20-1.04; P=.06). LFFS and RFFS were high in all groups and were not significantly different by diabetic status or metformin use.
  
  
  CONCLUSIONS
  Diabetic patients not using metformin independently have significantly higher rates of distant metastases than do nondiabetic patients, whereas metformin users have rates of distant metastases similar to those of nondiabetic patients. Further prospective investigation is warranted to validate the benefit of metformin in oropharyngeal cancer.
authors: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY.
authors: Daniel E
authors: DE
authors: Spratt
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Beth M
authors: BM
authors: Beadle
authors: Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles CA.|Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY.
authors: Zachary S
authors: ZS
authors: Zumsteg
authors: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY.
authors: Andrew
authors: A
authors: Rivera
authors: Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas.
authors: Heath D
authors: HD
authors: Skinner
authors: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
authors: Joseph R
authors: JR
authors: Osborne
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors: Adam S
authors: AS
authors: Garden
authors: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY.
authors: Nancy Y
authors: NY
authors: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary*; D003920:Diabetes Mellitus / Q000188:drug therapy*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008687:Metformin / Q000627:therapeutic use*; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy; D016016:Proportional Hazards Models; D012907:Smoking / Q000453:epidemiology
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin