Diabetes mellitus without metformin intake is associated with worse oncologic outcomes after radical nephroureterectomy for upper tract urothelial carcinoma

被引:34
作者
Rieken, M. [1 ,2 ]
Xylinas, E. [1 ,3 ]
Kluth, L. [1 ,4 ]
Trinh, Q-D [14 ,15 ]
Lee, R. K. [1 ]
Fajkovic, H. [13 ]
Novara, G. [7 ]
Margulis, V. [8 ]
Lotan, Y. [8 ]
Martinez-Salamanca, J. I. [9 ]
Matsumoto, K. [10 ]
Seitz, C. [13 ]
Remzi, M. [11 ]
Karakiewicz, P. I. [6 ]
Scherr, D. S. [1 ]
Briganti, A. [5 ]
Kautzky-Willer, A. [12 ]
Bachmann, A. [2 ]
Shariat, S. F. [1 ,13 ]
机构
[1] Weill Cornell Med Coll, New York Presbyterian Hosp, Dept Urol, New York, NY USA
[2] Univ Basel Hosp, Dept Urol, CH-4031 Basel, Switzerland
[3] Paris Descartes Univ, Cochin Hosp, APHP, Dept Urol, Paris, France
[4] Univ Med Ctr Hamburg Eppendorf, Dept Urol, Hamburg, Germany
[5] Univ Vita Salute San Raffaele, Dept Urol, Milan, Italy
[6] Univ Montreal, Dept Urol, Montreal, PQ, Canada
[7] Univ Padua, Urol Clin, Dept Surg Oncol & Gastroenterol Sci, I-35100 Padua, Italy
[8] Univ Texas SW Med Ctr Dallas, Dept Urol, Dallas, TX 75390 USA
[9] Univ Autonoma Madrid, Dept Urol, Hosp Univ Puerta de Hierro Majadahonda, Madrid, Spain
[10] Kitasato Univ, Sch Med, Dept Urol, Sagamihara, Kanagawa 228, Japan
[11] Landesklinikum Korneuburg, Dept Urol, Korneuburg, Austria
[12] Med Univ Vienna, Unit Gender Med, Div Endocrinol & Metab, Dept Internal Med 3, Vienna, Austria
[13] Med Univ Vienna, Dept Urol, Vienna, Austria
[14] Harvard Univ, Sch Med, Div Urol Surg, Boston, MA USA
[15] Harvard Univ, Sch Med, Dana Farber Canc Inst, Ctr Surg & Publ Hlth,Brigham & Womens Hosp, Boston, MA 02115 USA
来源
EJSO | 2014年 / 40卷 / 01期
基金
瑞士国家科学基金会;
关键词
Upper tract urothelial carcinoma; Diabetes mellitus; Metformin; Surgery; BLADDER-CANCER; RISK; RECURRENCE; MORTALITY; THERAPY; DISEASE; IMPACT;
D O I
10.1016/j.ejso.2013.09.016
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Aims: Evidence suggests a detrimental effect of diabetes. mellitus (DM) on cancer incidence and outcomes. To date, the effect of DM and its treatment on prognosis in upper tract urothelial carcinoma (UTUC) remains uninvestigated. We tested the hypothesis that DM and metformin use impact oncologic outcomes of patients treated with radical nephroureterectomy (RNU) for UTUC. Methods: Retrospective analysis of 2492 patients with UTUC treated at 23 institutions with RNU without neoadjuvant therapy. Cox regression models addressed the association of DM and metformin use with disease recurrence, cancer-specific mortality and any-cause mortality. Results: A total of 365 (14.3%) patients had DM and 194 (7.8%) patients used metformin. Within a median follow-up of 36 months, 663 (26.6%) patients experienced disease recurrence, 545 patients (21.9%) died of UTUC and 884 (35.5%) patients died from any cause. Diabetic patients who did not use metformin were at significantly higher risk of disease recurrence and cancer-specific death compared to nondiabetic patients and diabetic patients who used metformin. In multivariable Cox regression analyses, DM treated without metformin was associated with worse recurrence-free survival (HR: 1.44, 95% CI 1.10-1.90, p = 0.009) and cancer-specific mortality (HR: 1.49, 95% CI 1.11-2.00, p = 0.008). Conclusions: Diabetic UTUC patients without metformin use have significantly worse oncologic outcomes than diabetics who used metformin and non-diabetics. The possible mechanism behind the impact of DM on UTUC biology and the potentially protective effect of metformin need further elucidation. (C) 2013 Elsevier Ltd. All rights reserved.
引用
收藏
页码:113 / 120
页数:8
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