Association of diabetes mellitus and metformin use with oncological outcomes of patients with non-muscle-invasive bladder cancer

Malte Rieken, Evanguelos Xylinas, Luis Kluth, Joseph J. Crivelli, James Chrystal, Talia Faison, Yair Lotan, Pierre I. Karakiewicz, Harun Fajkovic, Marek Babjuk, Alexandra Kautzky-Willer, Alexander Bachmann, Douglas S. Scherr, Shahrokh F. Shariat

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Objective To assess the association between diabetes mellitus (DM) and metformin use with prognosis and outcomes of non-muscle-invasive bladder cancer (NMIBC) Patients and Methods We retrospectively evaluated 1117 patients with NMIBC treated at four institutions between 1996 and 2007. Cox regression models were used to analyse the association of DM and metformin use with disease recurrence, disease progression, cancer-specific mortality and any-cause mortality. Results Of the 1117 patients, 125 (11.1%) had DM and 43 (3.8%) used metformin. Within a median (interquartile range) follow-up of 64 (22-106) months, 469 (42.0%) patients experienced disease recurrence, 103 (9.2%) experienced disease progression, 50 (4.5%) died from bladder cancer and 249 (22.3%) died from other causes. In multivariable Cox regression analyses, patients with DM who did not take metformin had a greater risk of disease recurrence (hazard ratio [HR]: 1.45, 95% confidence interval [CI] 1.09-1.94, P = 0.01) and progression (HR: 2.38, 95% CI 1.40-4.06, P = 0.001) but not any-cause mortality than patients without DM. DM with metformin use was independently associated with a lower risk of disease recurrence (HR: 0.50, 95% CI 0.27-0.94, P = 0.03). Conclusion Patients with DM and NMIBC who do not take metformin seem to be at an increased risk of disease recurrence and progression; metformin use seems to exert a protective effect with regard to disease recurrence. The mechanisms behind the impact of DM on patients with NMIBC and the potential protective effect of metformin need further elucidation.

Original languageEnglish (US)
Pages (from-to)1105-1112
Number of pages8
JournalBJU International
Volume112
Issue number8
DOIs
StatePublished - Dec 2013

Fingerprint

Metformin
Urinary Bladder Neoplasms
Diabetes Mellitus
Recurrence
Disease Progression
Confidence Intervals
Mortality
Proportional Hazards Models
Regression Analysis

Keywords

  • diabetes mellitus
  • metformin
  • non-muscle-invasive bladder cancer
  • outcomes

ASJC Scopus subject areas

  • Urology

Cite this

Rieken, M., Xylinas, E., Kluth, L., Crivelli, J. J., Chrystal, J., Faison, T., ... Shariat, S. F. (2013). Association of diabetes mellitus and metformin use with oncological outcomes of patients with non-muscle-invasive bladder cancer. BJU International, 112(8), 1105-1112. https://doi.org/10.1111/bju.12448

Association of diabetes mellitus and metformin use with oncological outcomes of patients with non-muscle-invasive bladder cancer. / Rieken, Malte; Xylinas, Evanguelos; Kluth, Luis; Crivelli, Joseph J.; Chrystal, James; Faison, Talia; Lotan, Yair; Karakiewicz, Pierre I.; Fajkovic, Harun; Babjuk, Marek; Kautzky-Willer, Alexandra; Bachmann, Alexander; Scherr, Douglas S.; Shariat, Shahrokh F.

In: BJU International, Vol. 112, No. 8, 12.2013, p. 1105-1112.

Research output: Contribution to journalArticle

Rieken, M, Xylinas, E, Kluth, L, Crivelli, JJ, Chrystal, J, Faison, T, Lotan, Y, Karakiewicz, PI, Fajkovic, H, Babjuk, M, Kautzky-Willer, A, Bachmann, A, Scherr, DS & Shariat, SF 2013, 'Association of diabetes mellitus and metformin use with oncological outcomes of patients with non-muscle-invasive bladder cancer', BJU International, vol. 112, no. 8, pp. 1105-1112. https://doi.org/10.1111/bju.12448
Rieken, Malte ; Xylinas, Evanguelos ; Kluth, Luis ; Crivelli, Joseph J. ; Chrystal, James ; Faison, Talia ; Lotan, Yair ; Karakiewicz, Pierre I. ; Fajkovic, Harun ; Babjuk, Marek ; Kautzky-Willer, Alexandra ; Bachmann, Alexander ; Scherr, Douglas S. ; Shariat, Shahrokh F. / Association of diabetes mellitus and metformin use with oncological outcomes of patients with non-muscle-invasive bladder cancer. In: BJU International. 2013 ; Vol. 112, No. 8. pp. 1105-1112.
@article{b539d29133e9487499b1dde7c33dcc04,
title = "Association of diabetes mellitus and metformin use with oncological outcomes of patients with non-muscle-invasive bladder cancer",
abstract = "Objective To assess the association between diabetes mellitus (DM) and metformin use with prognosis and outcomes of non-muscle-invasive bladder cancer (NMIBC) Patients and Methods We retrospectively evaluated 1117 patients with NMIBC treated at four institutions between 1996 and 2007. Cox regression models were used to analyse the association of DM and metformin use with disease recurrence, disease progression, cancer-specific mortality and any-cause mortality. Results Of the 1117 patients, 125 (11.1{\%}) had DM and 43 (3.8{\%}) used metformin. Within a median (interquartile range) follow-up of 64 (22-106) months, 469 (42.0{\%}) patients experienced disease recurrence, 103 (9.2{\%}) experienced disease progression, 50 (4.5{\%}) died from bladder cancer and 249 (22.3{\%}) died from other causes. In multivariable Cox regression analyses, patients with DM who did not take metformin had a greater risk of disease recurrence (hazard ratio [HR]: 1.45, 95{\%} confidence interval [CI] 1.09-1.94, P = 0.01) and progression (HR: 2.38, 95{\%} CI 1.40-4.06, P = 0.001) but not any-cause mortality than patients without DM. DM with metformin use was independently associated with a lower risk of disease recurrence (HR: 0.50, 95{\%} CI 0.27-0.94, P = 0.03). Conclusion Patients with DM and NMIBC who do not take metformin seem to be at an increased risk of disease recurrence and progression; metformin use seems to exert a protective effect with regard to disease recurrence. The mechanisms behind the impact of DM on patients with NMIBC and the potential protective effect of metformin need further elucidation.",
keywords = "diabetes mellitus, metformin, non-muscle-invasive bladder cancer, outcomes",
author = "Malte Rieken and Evanguelos Xylinas and Luis Kluth and Crivelli, {Joseph J.} and James Chrystal and Talia Faison and Yair Lotan and Karakiewicz, {Pierre I.} and Harun Fajkovic and Marek Babjuk and Alexandra Kautzky-Willer and Alexander Bachmann and Scherr, {Douglas S.} and Shariat, {Shahrokh F.}",
year = "2013",
month = "12",
doi = "10.1111/bju.12448",
language = "English (US)",
volume = "112",
pages = "1105--1112",
journal = "BJU International",
issn = "1464-4096",
publisher = "Wiley-Blackwell",
number = "8",

}

TY - JOUR

T1 - Association of diabetes mellitus and metformin use with oncological outcomes of patients with non-muscle-invasive bladder cancer

AU - Rieken, Malte

AU - Xylinas, Evanguelos

AU - Kluth, Luis

AU - Crivelli, Joseph J.

AU - Chrystal, James

AU - Faison, Talia

AU - Lotan, Yair

AU - Karakiewicz, Pierre I.

AU - Fajkovic, Harun

AU - Babjuk, Marek

AU - Kautzky-Willer, Alexandra

AU - Bachmann, Alexander

AU - Scherr, Douglas S.

AU - Shariat, Shahrokh F.

PY - 2013/12

Y1 - 2013/12

N2 - Objective To assess the association between diabetes mellitus (DM) and metformin use with prognosis and outcomes of non-muscle-invasive bladder cancer (NMIBC) Patients and Methods We retrospectively evaluated 1117 patients with NMIBC treated at four institutions between 1996 and 2007. Cox regression models were used to analyse the association of DM and metformin use with disease recurrence, disease progression, cancer-specific mortality and any-cause mortality. Results Of the 1117 patients, 125 (11.1%) had DM and 43 (3.8%) used metformin. Within a median (interquartile range) follow-up of 64 (22-106) months, 469 (42.0%) patients experienced disease recurrence, 103 (9.2%) experienced disease progression, 50 (4.5%) died from bladder cancer and 249 (22.3%) died from other causes. In multivariable Cox regression analyses, patients with DM who did not take metformin had a greater risk of disease recurrence (hazard ratio [HR]: 1.45, 95% confidence interval [CI] 1.09-1.94, P = 0.01) and progression (HR: 2.38, 95% CI 1.40-4.06, P = 0.001) but not any-cause mortality than patients without DM. DM with metformin use was independently associated with a lower risk of disease recurrence (HR: 0.50, 95% CI 0.27-0.94, P = 0.03). Conclusion Patients with DM and NMIBC who do not take metformin seem to be at an increased risk of disease recurrence and progression; metformin use seems to exert a protective effect with regard to disease recurrence. The mechanisms behind the impact of DM on patients with NMIBC and the potential protective effect of metformin need further elucidation.

AB - Objective To assess the association between diabetes mellitus (DM) and metformin use with prognosis and outcomes of non-muscle-invasive bladder cancer (NMIBC) Patients and Methods We retrospectively evaluated 1117 patients with NMIBC treated at four institutions between 1996 and 2007. Cox regression models were used to analyse the association of DM and metformin use with disease recurrence, disease progression, cancer-specific mortality and any-cause mortality. Results Of the 1117 patients, 125 (11.1%) had DM and 43 (3.8%) used metformin. Within a median (interquartile range) follow-up of 64 (22-106) months, 469 (42.0%) patients experienced disease recurrence, 103 (9.2%) experienced disease progression, 50 (4.5%) died from bladder cancer and 249 (22.3%) died from other causes. In multivariable Cox regression analyses, patients with DM who did not take metformin had a greater risk of disease recurrence (hazard ratio [HR]: 1.45, 95% confidence interval [CI] 1.09-1.94, P = 0.01) and progression (HR: 2.38, 95% CI 1.40-4.06, P = 0.001) but not any-cause mortality than patients without DM. DM with metformin use was independently associated with a lower risk of disease recurrence (HR: 0.50, 95% CI 0.27-0.94, P = 0.03). Conclusion Patients with DM and NMIBC who do not take metformin seem to be at an increased risk of disease recurrence and progression; metformin use seems to exert a protective effect with regard to disease recurrence. The mechanisms behind the impact of DM on patients with NMIBC and the potential protective effect of metformin need further elucidation.

KW - diabetes mellitus

KW - metformin

KW - non-muscle-invasive bladder cancer

KW - outcomes

UR - http://www.scopus.com/inward/record.url?scp=84887263940&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84887263940&partnerID=8YFLogxK

U2 - 10.1111/bju.12448

DO - 10.1111/bju.12448

M3 - Article

C2 - 24053906

AN - SCOPUS:84887263940

VL - 112

SP - 1105

EP - 1112

JO - BJU International

JF - BJU International

SN - 1464-4096

IS - 8

ER -