Effects of metformin on prognosis of type Ⅰ endometrial carcinoma patients complicated with type 2 diabetes mellitus

Abstract

Abstract:

ObjectiveTo explore the effects of metformin on the prognosis of type Ⅰ endometrial carcinoma (EC) patients complicated with type 2 diabetes mellitus (T2DM).MethodsThe clinical data of 45 type Ⅰ EC patients complicated with T2DM (T2DM group) and 147 type Ⅰ EC patients without diabetes mellitus (non-diabetes group) admitted to Qilu Hospital of Shandong University from January 2010 to December 2014 were retrospectively analyzed. The type Ⅰ EC patients with T2DM were divided into two groups, metformin group (n=23, taking metformin to control blood glucose in normal range) and non-metformin group (n=22, taking other hypoglycemic drugs or using insulin to control blood glucose in normal range). The clinicopathological characteristics of T2DM group and non-diabetes group were compared, and the effects of metformin on the prognosis of type Ⅰ EC patients with T2DM were analyzed.ResultsCompared with non-diabetes group, the type Ⅰ EC patients in T2DM group have the older onset age (t=4.331,P<0.001), more complicated with hypertension (χ²=19.252,P<0.001), later surgical pathological stage (χ²=4.588,P=0.032), higher histological grade (χ²=6.069,P=0.048), deeper myometrial infiltration (χ²=7.743,P=0.005) and higher incidence of lymph node metastasis (χ²=4.885,P=0.027). The median progression-free survival (PFS) (47.0 monthsvs.38.0 months) and median overall survival (OS) (52.0 monthsvs. 41.0 months) in metformin group were significantly longer than those in non-metformin group (χ²=10.899,P=0.001;χ²=10.090,P=0.001). There was no significant difference in median PFS (47.0 monthsvs. 46.0 months) and median OS (52.0 monthsvs. 46.0 months) between metformin group and non-diabetes group (χ²=0.791,P=0.374;χ²=0.836,P=0.360). Cox multivariate analysis showed that the risk factors of PFS and OS in type ⅠEC patients were old onset age(OR=2.128, 95%CI: 1.361-3.328,P=0.001;OR=4.502, 95%CI: 1.696-11.954,P=0.003), late surgical pathological stage(OR=2.231, 95%CI: 1.437-3.462,P=0.001;OR=4.005, 95%CI: 1.480-10.836,P=0.006), high histological grade(P=0.001;P=0.017; G2vs.G1:OR=5.660, 95%CI: 3.424-9.357,P=0.001;OR=5.763, 95%CI: 1.666-19.938,P=0.006), deep myometrial invasion(OR=1.531, 95%CI: 1.049-2.235,P=0.027;OR=3.759, 95%CI: 1.890-7.476,P=0.001), positive lymph node metastasis (OR=11.277, 95%CI: 2.774-45.838,P=0.001;OR=8.451, 95%CI: 1.138-62.767,P=0.037)and T2DM (OR=1.897, 95%CI: 1.096-3.281,P=0.008;OR=1.813, 95%CI: 1.043-3.151,P=0.012). Metformin was the protective factor of PFS (OR=0.412, 95%CI: 0.207-0.818, P=0.002) and OS (OR=0.455, 95%CI: 0.228-0.905,P=0.008) in type Ⅰ EC patients with T2DM.ConclusionComplication with T2DM is the negative factor on the prognosis of type Ⅰ EC patients. Intake of metformin can significantly improve the PFS and OS of type Ⅰ EC patients complicated with T2DM and improve the prognosis.

Key words:Diabetes mellitus,type 2,Endometrial neoplasms,Metformin,Prognosis

Wang Xue, Ji Guoxin, Ji Chao, Yang Xingsheng. Effects of metformin on prognosis of type Ⅰ endometrial carcinoma patients complicated with type 2 diabetes mellitus[J]. Journal of International Oncology, 2020, 47(7): 404-408.

Figures/Tables4

临床病理特征	糖尿病组 (n=45)	非糖尿病组 (n=147)	t/χ²值	P值
发病年龄(岁)	59.6±8.8	53.6±8.2	4.331	<0.001
手术-病理分期(例)
Ⅰ~Ⅱ	34	130	4.588	0.032
Ⅲ~Ⅳ	11	17
组织学分级(例)
G1	16	72
G2	16	55	6.069	0.048
G3	13	20
肌层浸润深度(例)
无或浅肌层	25	113	7.743	0.005
深肌层	20	34
淋巴结转移(例)
阳性	8	10	4.885	0.027
阴性	37	137
合并高血压(例)
是	26	34	19.252	<0.001
否	19	113

参数	PFS			OS
参数	OR值	95%CI	P值	OR值	95%CI	P值
合并T2DM	1.897	1.096~3.281	0.008	1.813	1.043~3.151	0.012
服用二甲双胍	0.412	0.207~0.818	0.002	0.455	0.228~0.905	0.008
发病年龄	2.128	1.361~3.328	0.001	4.502	1.696~11.954	0.003
手术-病理分期	2.231	1.437~3.462	0.001	4.005	1.480~10.836	0.006
组织学分级			0.001			0.017
G2/G1	5.660	3.424~9.357	0.001	5.763	1.666~19.938	0.006
G3/G2	1.980	0.873~4.490	0.102	5.577	1.386~22.445	0.016
肌层浸润	1.531	1.049~2.235	0.027	3.759	1.890~7.476	0.001
淋巴结转移	11.277	2.774~45.838	0.001	8.451	1.138~62.767	0.037

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