J Korean Med Sci.  2016 Sep;31(9):1464-1471. 10.3346/jkms.2016.31.9.1464.

Impact of Glycemic Control and Metformin Use on the Recurrence and Progression of Non-Muscle Invasive Bladder Cancer in Patients with Diabetes Mellitus

• Ahn JH
• Jung SI
• Yim SU
• Kim SW
• Hwang EC
• Kwon DD

• KMID: 2468281
• DOI: http://doi.org/10.3346/jkms.2016.31.9.1464

Abstract

The purpose of the present study was to determine the potential relationships of glycemic control and use of metformin with non-muscle invasive bladder cancer characteristics. We reviewed data from 645 patients with non-muscle invasive bladder cancer between January 2004 and May 2015. We analyzed the association of pre and post-operative glycemic control and use of metformin with clinical characteristics of bladder tumors. We also analyzed the association of glycemic control and use of metformin with recurrence-free and progression-free survivals. Diabetes mellitus patients showed decreased recurrence-free survival (hazard ratio 1.42; 95% confidence interval 1.1-1.9; P = 0.021) and progression-free survival (hazard ratio 1.79; 95% confidence interval 1.1-2.8; P = 0.013). Diabetes mellitus patients with a HbA1c ≥ 7.0% demonstrated a higher rate of progression (P = 0.026). Kaplan-Meier analysis showed that progression-free survival rate was associated with poor baseline glycemic control (P = 0.026) and post-operative glycemic control (P = 0.025). However, use of metformin had no impact on the recurrence (P = 1.00) and progression (P = 0.282). In conclusion, poor baseline and post-operative glycemic control was related with shorter progression-free survival of patients with non-muscle invasive bladder cancer. Use of metformin had no impact on the recurrence and progression. Therefore, tight glycemic control and close follow-up for bladder tumor may be beneficial in patients with poor glycemic control.

Keyword

Diabetes Mellitus; Progression; Recurrence; Bladder Cancer; Metformin

MeSH Terms

Aged
Diabetes Mellitus, Type 2/complications/*drug therapy
Disease-Free Survival
Female
Glycated Hemoglobin A/analysis
Humans
Kaplan-Meier Estimate
Male
Metformin/*therapeutic use
Middle Aged
Neoplasm Recurrence, Local
Neoplasm Staging
Odds Ratio
Proportional Hazards Models
Retrospective Studies
Urinary Bladder Neoplasms/complications/mortality/*pathology/surgery
Glycated Hemoglobin A
Metformin

Figure

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  Fig. 1 Recurrence and progression-free survival according to diabetes mellitus status.

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  Fig. 2 Progression-free survival according to pre and post-operative glycemic control.

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