Prediagnosis metformin use improves survival in elderly diabetic HCC patients

Prediagnosis use of metformin dose ≤1,500 mg/d results in longer overall survival among elderly diabetic patients with hepatocellular carcinoma (HCC), according to a study.

The investigators analysed data on 2,499 elderly diabetic HCC patients obtained from the SEER-Medicare programme (2009 to 2013) to examine the effect of prediagnosis and postdiagnosis use of statins and metformin on overall survival in this population. They categorized patients based on use of statins only, metformin only, both or neither (reference for all comparisons).

Further categorization was performed according to the following: (1) metformin dose: ≤1,500 or >1,500 mg/d; (2) statins functional form: hydrophilic (pravastatin and rosuvastatin) or lipophilic (atorvastatin, fluvastatin, lovastatin and simvastatin); (3) statins potency: high (atorvastatin, rosuvastatin and simvastatin) or low (fluvastatin, lovastatin and pravastatin); and (4) individual statins type.

Cox proportional hazard models were generated to calculate for multivariable-adjusted hazard ratios (HR) and 95 percent confidence intervals (CIs).

Prediagnosis use of metformin dose ≤1,500 mg/d led to a reduced risk of death following HCC diagnosis in patients with type 2 diabetes mellitus (HR, 0.72, 95 percent CI, 0.58–0.91), adjusting for postdiagnosis metformin dose, diabetes severity, Charlson comorbidity index, tumour characteristics and other relevant factors.

On the other hand, prediagnosis metformin dose >1,500 mg/d or postdiagnosis metformin use was not associated with a lower mortality risk. There was also no association seen for either prediagnosis or postdiagnosis use of statins.

“Statins and metformin have received considerable interest as potential chemopreventive agents against HCC development in individuals with type 2 diabetes mellitus,” the investigators noted.