title: Metformin use improves survival of diabetic liver cancer patients: systematic review and meta-analysis.
abstract: Metformin has garnered considerable interest as a chemo-preventive and chemo-therapeutic agent given the increased risk of liver cancer among diabetic patients. This work was performed to illustrate the association between metformin use and survival of diabetic liver cancer patients. We conducted a comprehensive literature search of PubMed, Web of Science, Embase, BIOSIS Previews, Cochrane Library from inception to 12 May 2016. Meta-analyses were performed using Stata (version 12.0), with hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) as effect measures. Eleven cohort studies involving 3452 liver cancer patients fulfilled the inclusion criteria. Meta-analyses showed that metformin use was associated with better survival (HR = 0.59; 95% CI, 0.42-0.83; p = 0.002) of liver cancer patients, and the beneficial effect persisted (HR = 0.64; 95% CI, 0.42-0.97; p = 0.035) when the population was restricted to diabetic liver cancer patients. After adjusting for age, etiology, index of tumor severity and treatment of liver cancer, the association between metformin use and better survival of liver cancer patients was stable, pooled HR ranged from 0.47 to 0.57. The results indicated that metformin use improved survival of diabetic liver cancer patients. However, the results should be interpreted with caution given the possibility of residual confounding. Further prospective studies are still needed to confirm the prognostic benefit of metformin use.
authors: Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.
authors: Shu-Juan
authors: SJ
authors: Ma
authors: Department of Infectious Disease, Viral Hepatitis Key Laboratory of Hunan Province, Xiangya Hospital, Central South University, Changsha, China.
authors: Yi-Xiang
authors: YX
authors: Zheng
authors: Department of Infectious Disease, Viral Hepatitis Key Laboratory of Hunan Province, Xiangya Hospital, Central South University, Changsha, China.
authors: Peng-Cheng
authors: PC
authors: Zhou
authors: Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.
authors: Yan-Ni
authors: YN
authors: Xiao
authors: Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China.
authors: Hong-Zhuan
authors: HZ
authors: Tan
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008113:Liver Neoplasms / Q000150:complications / Q000188:drug therapy*; D008687:Metformin / Q000627:therapeutic use*; D011379:Prognosis
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin
keywords: diabetes mellitus; liver cancer; meta-analysis; metformin; survival