BioMed Research International

Review Article

The Impact of Metformin Use with Survival Outcomes in Urologic Cancers: A Systematic Review and Meta-Analysis

Table 1

Characteristics of included studies.
Tumor groupAuthor (year) [ref.]TreatmentStage/other restrictionsSample size (met/total)Study locationSettingDMNon-DMRecurrenceProgressionCSSOSDefinition of metformin exposureMedian follow-up (months)Adjusting variablesNOS score
Renal cell carcinomaHakimi et al. (2013) [23]Partial/radical nephrectomyT2–T3 N0 M055/784USAH✓✓✓✓✓✓At surgery41Age, BMI, race, etc.6
Nayan et al. (2016) [24] (PR)Not specifiedLocalizedNA/613CanadaHX✓XX✓✓At diagnosis40Age, sex BMI, nuclear grade8
Psutka et al. (2015) [28]Partial/radical nephrectomyLocalized83/200USAH✓XX✓✓✓90 days before surgery97Mayo clinic, clinic stage, size, etc.8
Cheng et al. (2016) [29] (localized)Partial/radical nephrectomyT1–T3 N1 M1390/1528SingaporeHX✓X✓✓✓At diagnosis43Not given6
Cheng et al. (2016) [29] (metastatic)Partial/radical nephrectomyT1–T3 N1 M1390/1528SingaporeHX✓X✓✓✓At diagnosis43Not given6
Keizman et al. (2016) [30]Systemic therapyMetastatic52/108IsraelH✓XX✓X✓At diagnosisNAAge, sex, race, ECOG status, histology, etc.6
Hamieh et al. (2017) [31]Partial/radical nephrectomyMetastatic218/4736USAH✓✓X✓X✓At diagnosisNAAge, gender race, previous therapy, etc.8
Nayan et al. (2017) [32] (CGC)Partial/radical nephrectomyT1–T3 N1 M082/158CanadaHX✓XX✓✓At surgery43Not given8
Urothelial carcinomaAhn et al. (2016) [22]TURBTpTa–pT1127/645KoreaH✓✓✓✓XXAt diagnosis46Age, sex, BMI, DM, hypertension, tumor size, smoking, etc.7
Rieken et al. (2013) [33] (BJU)TURBTpTa–pT1 N0 M043/1035USA and EuropeHX✓✓✓✓✓At surgery64Age, tumor stage and grade, tumor size, etc.8
Rieken et al. (2014) [34] (UO)Radical surgerypT0-pT4 M080/1382USA and EuropeHX✓✓X✓✓At diagnosis34Age, sex, BMI, smoking, tumor stage and grade, etc.8
Rieken et al. (2014) [35] (EJSO)Radical surgerypT0-pT4 M0194/2330USA and EuropeHX✓✓X✓✓At surgery36Age, sex, BMI, tumor stage, etc.6
Nayan et al. (2015) [36]Radical surgerypT0-pT4 N1 M039/421CanadaHX✓✓X✓✓At diagnosis50Age, sex, BMI, GFR, etc.8
Prostate carcinomaDanzig et al. (2015) [20]ProstatectomyLocalized98/767USAH✓X✓XXXAt surgery27Not given6
Allott et al. (2013) [21]ProstatectomyLocalized155/369USAH✓X✓X✓XAt surgery59/73bAge, sex, race, BMI, preoperative PSA, etc.8
Patel et al. (2010) [37]Radical prostatectomyLocalized112/616USAHX✓✓XXXAt diagnosisNAAge, clinical stage, preoperative PSA, etc.7
He et al. (2011) [38]Prostatectomy/radical radiotherapyLocalizedNR/233USAHX✓✓XXXAt diagnosis55Age, sex, Gleason score, clinical stage8
Margel et al. (2013) [39]Prostatectomy/ADTLocalizeda/≥66 years old1251/3837CanadaP✓XXX✓✓Cumulative exposure56Age, urban, Gleason score, etc.8
Spratt et al. (2013) [40]Radical radiotherapyLocalized157/319USAH✓X✓X✓✓At diagnosis or after104Age, Gleason score, tumor stage, etc.8
Zannella et al. (2013) [41]Radical radiotherapyLocalized114/504CanadaH✓✓✓XXXAt the time of radiotherapy82Age, PSA value, Gleason score, follow-up time, etc.5
Kaushik et al. (2014) [42]ProstatectomyLocalized323/885USAH✓X✓✓X✓3 months before surgery61Age, BMI, Gleason score, stage, margin, etc.7
Rieken et al. (2014) [43] (WJU)ProstatectomyLocalizeda/≥66 years old287/6486USA and EuropeHX✓✓XXXAt surgery25Age, PSA value, Gleason score, lymph node metastasis, etc.6
Taira et al. (2014) [44]BrachytherapyLocalized126/2298USAH✓✓✓XX✓Diagnosis to 3 months after100Age, follow-up years, PSA value, etc.7
Lee et al. (2015) [45]Radical prostatectomyT1–T4 N1 M0209/746KoreaHX✓✓XXX3 months before surgery43Age, BMI, PSA, prostate volume, etc.7
Winters et al. (2015) [46]Radical radiotherapyLocalized366/1734USAH✓✓✓XXXAt diagnosis41Age, race, BMI, DM, etc.7
Joentausta et al. (2016) [47]Radical prostatectomyLocalized133/1314FinlandH✓X✓XX✓At diagnosis103Age, PSA level, Gleason score, tumor stage, etc.8
Richards et al. (2018) [48]ADTLocalized18940/87344USAH✓✓✓X✓✓At diagnosis24Age, race, etc.6
Taussky et al. (2018) [49]Radical radiotherapyLocalized281/2441CanadaH✓✓✓XX✓At the time of radiotherapy48Age, CAPRA score, type of treatment7
H: hospital; P: population; met: metformin; DM: diabetes mellitus; NOS: Newcastle–Ottawa Quality Assessment Scale for Cohort Studies; NA: not applicable; OS: overall survival; CSS: cancer-specific survival; BMI: body mass index; PSA: prostate-specific antigen; GFR: glomerular filtration rate; ECOG: electrocorticography; CAPRA: Cancer of the Prostate Risk Assessment; NA: not available. aData from subanalysis. bMetformin/nonmetformin.