Survival benefit associated with metformin use in inoperable non-small cell lung cancer patients with diabetes: A population-based retrospective cohort study

Min-Chun Chuang; Yao-Hsu Yang; Ying-Huang Tsai; Meng-Jer Hsieh; Yu-Ching Lin; Chin-Kuo Lin; Pau-Chung Chen; Tsung-Ming Yang

doi:10.1371/journal.pone.0191129

Survival benefit associated with metformin use in inoperable non-small cell lung cancer patients with diabetes: A population-based retrospective cohort study

PLoS One. 2018 Jan 12;13(1):e0191129. doi: 10.1371/journal.pone.0191129. eCollection 2018.

Authors

Min-Chun Chuang^{1

2}, Yao-Hsu Yang^{3

4

5}, Ying-Huang Tsai⁶, Meng-Jer Hsieh¹, Yu-Ching Lin¹, Chin-Kuo Lin¹, Pau-Chung Chen^{7

8}, Tsung-Ming Yang¹

Affiliations

¹ Department of Pulmonary and Critical Care Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.
² Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan.
³ Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.
⁴ Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan.
⁵ School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
⁶ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan.
⁷ Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan.
⁸ Department of Environmental and Occupational Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.

Abstract

Objective: To evaluate the effects of metformin use on the survival of inoperable non-small cell lung cancer (NSCLC) patients with diabetes using the Taiwanese National Health Insurance Research Database.

Research design and methods: In total, 7,620 patients were eligible in this study, among them, 3,578 patients were metformin users and 4,042 were non-users. Propensity score matching was used to reduce possible confounding factors. In total, 4,182 patients (2,091 matched pairs) were included in the matched cohort. Cox proportional hazard model with time-dependent covariate were also applied to evaluate the association between metformin use and overall survival (OS).

Results: A total of 3,578 patients were metformin users at the time of diagnosis of NSCLC. Cox proportional hazard model with time-dependent covariate revealed that metformin use was associated with a significantly longer OS (HR: 0.85, 95.0% CI: 0.80-0.90). The survival benefit of metformin use was maintained after propensity score matching at a ratio of 1:1 (HR: 0.90, 95.0% CI: 0.84-0.97).

Conclusions: Metformin use is associated with longer OS in inoperable NSCLC patients with diabetes, suggesting a potential anti-tumorigenic effect for metformin. Further research is needed to investigate the actual role of metformin in the treatment of NSCLC patients with diabetes.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Carcinoma, Non-Small-Cell Lung / complications*
Diabetes Mellitus / drug therapy*
Female
Humans
Hypoglycemic Agents / therapeutic use*
Lung Neoplasms / complications*
Male
Metformin / administration & dosage*
Middle Aged
Proportional Hazards Models
Retrospective Studies
Survival Analysis
Taiwan

Substances

Hypoglycemic Agents
Metformin

Grants and funding

This study was supported by a grant from Chiayi Chang Gung Memorial Hospital, Taiwan (CORPG6D0162) and (CLRPG6G0041) to YHY. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.