title: Metformin use and its effect on survival in diabetic patients with advanced non-small cell lung cancer.
abstract: Previous population-based studies have demonstrated an association between metformin use and improved survival among diabetic patients with cancer. We sought to analyze the effects of diabetes and its treatment in terms of the survival of patients with lung cancer.
  
  
  
  Overall, 1106 patients with non-small cell lung cancer (94.3 % with stage IV disease) were included. The outcomes were compared between the patients with (n = 186) and without diabetes (n = 920). The characteristics associated with antidiabetic treatment and proper glycemic control (defined as a mean plasma glucose <130 mg/dL) were examined at diagnosis. The overall survivals (OSs) of the different patient populations were analyzed using Kaplan-Meier curves, and a multivariate Cox proportional hazard model was used to determine the influences of the patient and tumor characteristics on survival.
  
  
  
  The OS for the entire population was 18.3 months (95 % CI 16.1-20.4). There was no difference in the OSs of the diabetic and non-diabetic patients (18.5 vs 16.4 months, p = 0.62). The diabetic patients taking metformin exhibited a superior OS than did those on other antidiabetic treatments (25.6 vs 13.2 months, p = 0.017). Those with proper glycemic control had a better OS than did those without proper glycemic control and the non-diabetics (40.5 vs 13.2 and 18.5 months, respectively, p < 0.001). Both the use of metformin (HR 0.53, p < 0.0001 and HR 0.57, p = 0.017, respectively) and proper glycemic control (HR 0.49, p < 0.0001 and HR 0.40, p = 0.002, respectively) were significant protective factors in all and only diabetic patients, respectively.
  
  
  
  The diabetic patients with proper glycemic control exhibited a better OS than did those without proper glycemic control and even exhibited a better OS than did the patients without diabetes mellitus. Metformin use was independently associated with a better OS.
authors: Thoracic Oncology Unit and Laboratory of Personalized Medicine, Instituto Nacional de Cancerología (INCan), Av. San Fernando 22 Col. Sección XVI, Tlalpan, 14080, Mexico City, Mexico. ogar@unam.mx.
authors: Oscar
authors: O
authors: Arrieta
authors: Thoracic Oncology Unit and Laboratory of Personalized Medicine, Instituto Nacional de Cancerología (INCan), Av. San Fernando 22 Col. Sección XVI, Tlalpan, 14080, Mexico City, Mexico.
authors: Edgar
authors: E
authors: Varela-Santoyo
authors: Cancer Care in the Elderly Clinic, Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
authors: Enrique
authors: E
authors: Soto-Perez-de-Celis
authors: Thoracic Oncology Unit and Laboratory of Personalized Medicine, Instituto Nacional de Cancerología (INCan), Av. San Fernando 22 Col. Sección XVI, Tlalpan, 14080, Mexico City, Mexico.
authors: Roberto
authors: R
authors: Sánchez-Reyes
authors: Thoracic Oncology Unit and Laboratory of Personalized Medicine, Instituto Nacional de Cancerología (INCan), Av. San Fernando 22 Col. Sección XVI, Tlalpan, 14080, Mexico City, Mexico.
authors: Martha
authors: M
authors: De la Torre-Vallejo
authors: Thoracic Oncology Unit and Laboratory of Personalized Medicine, Instituto Nacional de Cancerología (INCan), Av. San Fernando 22 Col. Sección XVI, Tlalpan, 14080, Mexico City, Mexico.
authors: Saé
authors: S
authors: Muñiz-Hernández
authors: Clinical and Translational Oncology Group, Institute of Oncology, Clínica del Country, Bogotá, Colombia.|Foundation for Clinical and Applied Cancer Research - FICMAC, Bogotá, Colombia.
authors: Andrés F
authors: AF
authors: Cardona
mesh_terms: D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D008175:Lung Neoplasms / Q000401:mortality*; D008297:Male; D008687:Metformin / Q000008:administration & dosage* / Q000627:therapeutic use; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin
keywords: Carcinoma; Diabetes mellitus; Hypoglycemic agents; Metformin; Non-Small-Cell Lung