title: Metformin use and survival after non-small cell lung cancer: A cohort study in the US Military health system.
abstract: Research suggests that metformin may be associated with improved survival in cancer patients with type II diabetes. This study assessed whether metformin use after non-small cell lung cancer (NSCLC) diagnosis is associated with overall survival among type II diabetic patients with NSCLC in the U.S. military health system (MHS). The study included 636 diabetic patients with histologically confirmed NSCLC diagnosed between 2002 and 2007, identified from the linked database from the Department of Defense's Central Cancer Registry (CCR) and the Military Health System Data Repository (MDR). Time-dependent multivariate Cox proportional hazards models were used to assess the association between metformin use and overall survival during follow-up. Among the 636 patients, 411 died during the follow-up. The median follow-up time was 14.6 months. Increased post-diagnosis cumulative use (per 1 year of use) conferred a significant reduction in mortality (adjusted hazard ratio (HR) = 0.76; 95% CI = 0.65-0.88). Further analysis by duration of use revealed that compared to non-users, the lowest risk reduction occurred among patients with the longest duration of use (i.e. use for more than 2 years) (HR = 0.19; 95% CI = 0.09-0.40). Finally, the reduced mortality was particularly observed only among patients who also used metformin before lung cancer diagnosis and among patients at early stage of diagnosis. Prolonged duration of metformin use in the study population was associated with improved survival, especially among early stage patients. Future research with a larger number of patients is warranted.
authors.affiliation: John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD.
authors.forename: Jie
authors.identifier: 0000-0002-7840-2806
authors.initials: J
authors.lastname: Lin
authors.affiliation: John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD.
authors.forename: Abegail
authors.initials: A
authors.lastname: Gill
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.
authors.forename: Shelia H
authors.initials: SH
authors.lastname: Zahm
authors.affiliation: John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD.
authors.forename: Corey A
authors.initials: CA
authors.lastname: Carter
authors.affiliation: John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD.|Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD.
authors.forename: Craig D
authors.initials: CD
authors.lastname: Shriver
authors.affiliation: John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD.
authors.forename: Joel A
authors.initials: JA
authors.lastname: Nations
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.
authors.forename: William F
authors.initials: WF
authors.lastname: Anderson
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: McGlynn
authors.affiliation: John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD.|Department of Preventive Medicine and Biostatistics, Uniformed Services University of Health Sciences, Bethesda, MD.
authors.forename: Kangmin
authors.identifier: 0000-0001-8957-6820
authors.initials: K
authors.lastname: Zhu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D008175:Lung Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D008297:Male; D008687:Metformin / Q000008:administration & dosage* / Q000627:therapeutic use; D008875:Middle Aged; D008889:Military Personnel / Q000706:statistics & numerical data; D009367:Neoplasm Staging; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin
keywords: metformin; non-small cell lung cancer; survival; type II diabetes