Abstract
Background
Metformin may improve the prognosis in gastric adenocarcinoma, but the existing literature is limited and contradictory.
Methods
This was a Swedish population-based cohort study of diabetes patients who were diagnosed with gastric adenocarcinoma in 2005–2018 and followed up until December 2019. The data were retrieved from four national health data registries: Prescribed Drug Registry, Cancer Registry, Patient Registry and Cause of Death Registry. Associations between metformin use before the gastric adenocarcinoma diagnosis and the risk of disease-specific and all-cause mortality were assessed using multivariable Cox proportional hazard regression. The hazard ratios (HRs) and 95% confidence intervals (CIs) were adjusted for sex, age, calendar year, comorbidity, use of non-steroidal anti-inflammatory drugs or aspirin, and use of statins.
Results
Compared with non-users, metformin users had a decreased risk of disease-specific mortality (HR 0.79, 95% CI 0.67–0.93) and all-cause mortality (HR 0.78, 95% CI 0.68–0.90). The associations were seemingly stronger among patients of female sex (HR 0.66, 95% CI 0.49–0.89), patients with tumour stage III or IV (HR 0.71, 95% CI 0.58–0.88), and those with the least comorbidity (HR 0.71, 95% CI 0.57–0.89).
Conclusions
Metformin use may improve survival in gastric adenocarcinoma among diabetes patients.
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Contributions
All listed authors designed the study. J.L. and S.X. collected the data for the study. J.Z and G.S. analysed the data. J.Z. interpreted the results and drafted the manuscript. All listed authors revised the manuscript and approved the final version of the article, including the authorship list. J.L. is the guarantor of this work. Both J.L. and the corresponding author had full access to all the data in the study and final responsibility for the decision to submit for publication.
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Ethics approval and consent to participate
The study was conducted in accordance with the “Declaration of Helsinki”, and was approved by the Regional Ethical Review Board in Stockholm (2018/271-32). No individual informed consent was needed according to the Swedish regulation.
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Data availability
All the data were retrieved from the Swedish Prescribed Drugs and Health Cohort. The original data are available from the registries listed above, but restrictions apply to the availability of these data, which were used under license for the current study and therefore are not publicly available. Data may however be available through applications to these registries or reasonable request to the corresponding author (S.X.). The codes for the data analysis are archived by the first author (J.Z.).
Competing interests
The authors declare no competing interests.
Funding information
This work was supported by the Swedish Cancer Society (grant number 180684 to J.L. and 190043 to S.X.); and the Swedish Research Council (grant number 2019-00209 to J.L.). J.Z. receives a scholarship from China Scholarship Council (student number 201700260292). The founding resources were not involved in the study design, data collection, data analysis and interpretation of the results; nor in the writing of the report; and in the decision to submit the article for publication.
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Zheng, J., Santoni, G., Xie, SH. et al. Improved prognosis in gastric adenocarcinoma among metformin users in a population-based study. Br J Cancer 125, 277–283 (2021). https://doi.org/10.1038/s41416-021-01408-8
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DOI: https://doi.org/10.1038/s41416-021-01408-8
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