title: Impact of Glycemic Control and Metformin Use on the Recurrence and Progression of Non-Muscle Invasive Bladder Cancer in Patients with Diabetes Mellitus.
abstract: The purpose of the present study was to determine the potential relationships of glycemic control and use of metformin with non-muscle invasive bladder cancer characteristics. We reviewed data from 645 patients with non-muscle invasive bladder cancer between January 2004 and May 2015. We analyzed the association of pre and post-operative glycemic control and use of metformin with clinical characteristics of bladder tumors. We also analyzed the association of glycemic control and use of metformin with recurrence-free and progression-free survivals. Diabetes mellitus patients showed decreased recurrence-free survival (hazard ratio 1.42; 95% confidence interval 1.1-1.9; P = 0.021) and progression-free survival (hazard ratio 1.79; 95% confidence interval 1.1-2.8; P = 0.013). Diabetes mellitus patients with a HbA1c ≥ 7.0% demonstrated a higher rate of progression (P = 0.026). Kaplan-Meier analysis showed that progression-free survival rate was associated with poor baseline glycemic control (P = 0.026) and post-operative glycemic control (P = 0.025). However, use of metformin had no impact on the recurrence (P = 1.00) and progression (P = 0.282). In conclusion, poor baseline and post-operative glycemic control was related with shorter progression-free survival of patients with non-muscle invasive bladder cancer. Use of metformin had no impact on the recurrence and progression. Therefore, tight glycemic control and close follow-up for bladder tumor may be beneficial in patients with poor glycemic control.
authors: Department of Urology, Chonnam National University Medical School, Gwangju, Korea.
authors: Ji Hoon
authors: http://orcid.org/0000-0002-9658-8501
authors: JH
authors: Ahn
authors: Department of Urology, Chonnam National University Medical School, Gwangju, Korea. drjsi@yahoo.co.kr.
authors: Seung Il
authors: http://orcid.org/0000-0003-4864-8175
authors: SI
authors: Jung
authors: Department of Urology, Chonnam National University Medical School, Gwangju, Korea.
authors: Sang Un
authors: http://orcid.org/0000-0002-6555-9126
authors: SU
authors: Yim
authors: Department of Urology, Chonnam National University Medical School, Gwangju, Korea.
authors: Sun Woo
authors: http://orcid.org/0000-0001-5243-1564
authors: SW
authors: Kim
authors: Department of Urology, Chonnam National University Medical School, Gwangju, Korea.
authors: Eu Chang
authors: http://orcid.org/0000-0002-2031-124X
authors: EC
authors: Hwang
authors: Department of Urology, Chonnam National University Medical School, Gwangju, Korea.
authors: Dong Deuk
authors: http://orcid.org/0000-0002-4544-5420
authors: DD
authors: Kwon
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D018572:Disease-Free Survival; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008687:Metformin / Q000627:therapeutic use*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology* / Q000601:surgery
chemical_list: D006442:Glycated Hemoglobin; D008687:Metformin; C517652:hemoglobin A1c protein, human
keywords: Bladder Cancer; Diabetes Mellitus; Metformin; Progression; Recurrence