Cause-specific mortality in endometrioid endometrial cancer patients with type 2 diabetes using metformin or other types of antidiabetic medication

• Published in: Gynecologic oncology 2017-12, Vol.147 (3), p.678-683
• Main Authors: Arima, R., Hautakoski, A., Marttila, M., Arffman, M., Sund, R., Ilanne-Parikka, P., Kangaskokko, J., Hinkula, M., Puistola, U., Läärä, E.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Antidiabetic medication; Carcinoma, Endometrioid - complications; Carcinoma, Endometrioid - mortality; Cause-specific mortality; Cohort Studies; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - mortality; Endometrial cancer; Endometrial Neoplasms - complications; Endometrial Neoplasms - mortality; Endometrioid; Female; Finland - epidemiology; Humans; Metformin; Middle Aged; Registries; Retrospective cohort study; Retrospective Studies
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2017.10.014

To obtain further evidence of the association between metformin or other types of antidiabetic medication (ADM) and mortality from endometrial cancer (EC) and other causes of death in patients with endometrioid EC and type 2 diabetes (T2D). A retrospective cohort of women with existing T2D and diagnosed with endometrioid EC from 1998 to 2011, obtained from a nationwide diabetes database (FinDM), were included in the study. Cumulative mortality from EC and that from other causes was described by using the Aalen-Johansen estimator. Cause-specific mortality rates were analyzed by using Cox models, and adjusted hazard ratios (HRs) with 95% confidence intervals (95% CIs) were estimated in relation to the use of different forms of ADM during the three-year period preceding EC diagnosis. From the FinDM cohort we identified 1215 women diagnosed with endometrioid EC, of whom 19% were metformin users, 12% were users of other types of oral antidiabetic medication, 25% used other types of oral antidiabetic medication plus metformin, 26% used insulin and 14% had no antidiabetic medication. Mortality from EC was not found to be different in women using metformin (HR 0.89, 95% Cl 0.52–1.54) but mortality from other causes was lower (HR 0.52, 95% Cl 0.31–0.88) compared with women using other types of oral ADM. Our findings are inconclusive as to the possible effect of metformin on the prognosis of endometrioid EC in women with T2D. However, use of metformin may reduce mortality from other causes. •Our findings were inconclusive regarding the possible effect of metformin on the prognosis of endometrioid EC in women with T2D.•Mortality from other causes was lower in metformin users compared to those with other forms of oral antidiabetic medication.•Our results on non-EC mortality are consistent with other studies on metformin use and mortality.