Metformin Use Is Associated with Reduced Incidence and Improved Survival of Endometrial Cancer: A Meta-Analysis

Yun-Liang Tang, Ling-Yan Zhu, Yu Li, Jiao Yu, Jiao Wang, Xiang-Xia Zeng, Kai-Xiang Hu, Jian-Ying Liu, Ji-Xiong Xu, Yun-Liang Tang, Ling-Yan Zhu, Yu Li, Jiao Yu, Jiao Wang, Xiang-Xia Zeng, Kai-Xiang Hu, Jian-Ying Liu, Ji-Xiong Xu

Abstract

Studies have suggested that metformin can potentially decrease the incidence of cancer and improve survival outcomes. However, the association between metformin use and the incidence and survival of endometrial cancer (EC) remains controversial. So, a meta-analysis was performed. An electronic search was conducted using PubMed, EMBASE, and Web of Science. The outcome measures were relative risks (RRs) or hazard ratios (HRs) with 95% confidence intervals (CIs) comparing the EC incidence and survival in patients treated with and without metformin. Eleven studies involving 766,926 participants were included in this study. In the pooled analysis of five studies which evaluated the association of metformin use with the incidence of EC, we found that metformin use was associated with a 13% reduction in EC risk among patients with diabetes (RR = 0.87, 95% CI: 0.80-0.95; p = 0.006). In the pooled analysis of six retrospective cohort studies evaluating the effect of metformin on the survival of EC patients, we found that, relative to nonuse, metformin use significantly improved the survival of EC patients (HR = 0.63, 95% CI: 0.45-0.87; p = 0.006). This study showed that metformin use was significantly associated with a decreased incidence of EC in diabetes and a favorable survival outcome of EC patients.

Figures

Figure 1
Figure 1
Flow diagram of study selection.
Figure 2
Figure 2
Forest plot of the association between metformin use and incidence of endometrial cancer.
Figure 3
Figure 3
Forest plot of the association between metformin use and survival of endometrial cancer.
Figure 4
Figure 4
Begg's funnel plots for publication bias test on the association of metformin use with the incidence of endometrial cancer (p = 0.231 for Egger's test and p = 0.707 for Begg's test).
Figure 5
Figure 5
Begg's funnel plots for publication bias test on the association of metformin use with the survival of endometrial cancer (p = 0.220 for Egger's test and p = 0.806 for Begg's test).

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