Effect of metformin on clinical-pathological variables in women with endometrial cancer. A multicenter study

Objective: Endometrial cancer (EC) is the most common gynecological malignancy in economically developed countries. Documented risk factors include diabetes mellitus and obesity. Metformin, a derivative of biguanide, applied in treatment of type 2 diabetes, also has anti-neoplastic effects. The analysis presented below represents an attempt to determine the effects of metformin on clinical-pathological variables of EC, linked to the morbidity and course of EC. Material and Methods: 1,305 patients with EC were included in this retrospective study, the control group consisted of 1,016 EC patients who were diabetes-free, 144 patients with EC and type 2 diabetes treated with metformin, and 145 patients with EC and type 2 diabetes treated with other antidiabetic agents. The analyzed variables included age upon diagnosis of EC, BMI, parity, clinical stage according to FIGO, histological type of cancer (type I or type II EC), grading, type of surgery, adjuvant treatment (radio- or chemotherapy), and comorbidities. Results: EC in females with type 2 diabetes treated with metformin or other antidiabetic agents were diagnosed at a more advanced age than those in the control group. Both groups of patients with type 2 diabetes manifested morbid obesity significantly more frequently than the control group. Advanced stages of cancer were detected less frequently among metformin users compared to the control group and among patients with diabetes treated with other antidiabetic agents. Moreover, in the metformin group, total abdominal hysterectomy and adnexectomy were less common than in the remaining groups. Adjuvant radiotherapy was applied more frequently in the metformin-treated group. Both groups of type 2 diabetes patients were also more likely to suffer from hypertension. Conclusion: Compared to the control group, women with EC and diabetes mellitus were diagnosed at a more advanced age. A lower percentage of women with EC using metformin were diagnosed at advanced stages of EC according to FIGO in contrast to the control group and the group with diabetes treated with other antidiabetic agents. Patients treated with metformin underwent TAHBSO less frequently, but radiotherapy was applied more often. The present results show that type 2 diabetes patients also suffer from hypertension more frequently regardless of the diabetes treatment applied.

Endometrial cancer; Type 2 diabetes; Metformin

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