Evidence map›Metformin × all-cause mortality›PMID 24258613›Full record

SynthesisThe oncologist2013

Metformin is associated with survival benefit in cancer patients with concurrent type 2 diabetes: a systematic review and meta-analysis.

Ming Yin, Jie Zhou, Edward J Gorak, Fahd Quddus

Open access · bronzeAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in The oncologist, 2013. The graph read 2 numbers from its abstract, feeding 1 cell of the map, but none could be read as for or against, so it casts no vote. It also reports 2 associations that do not count as treatment evidence, such as HR 0.66 (0.55 to 0.79) for overall survival (OS). Cited by 82 papers, 11 of them syntheses that pooled it.

2numbers the graph read from it
0cells of the map it votes in
82citing papers in PubMed, 11 pooled it
9.1field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

Read, but not usablea number the graph found but could not read as for or against

Overall survival (OS)metformin treatment vs treatment with other glucose-lowering medicationsan association or prognostic statement, not a treatment comparison · t2dfeeds one cell of the map
HR 0.660.55 to 0.79
RESULTS: We found that there was a relative survival benefit associated with metformin treatment compared with treatment with other glucose-lowering medications in both OS and CSS (hazard ratio [HR] = 0.66; 95% confidence interval [CI]: 0.55-0.79 and HR = 0.62; 95% CI: 0.46-0.84, respectively).
FeedsMetformin×all-cause mortality
Cancer-specific survival (CSS)metformin treatment vs treatment with other glucose-lowering medicationsan association or prognostic statement, not a treatment comparison · t2dfeeds one cell of the map
HR 0.620.46 to 0.84
RESULTS: We found that there was a relative survival benefit associated with metformin treatment compared with treatment with other glucose-lowering medications in both OS and CSS (hazard ratio [HR] = 0.66; 95% confidence interval [CI]: 0.55-0.79 and HR = 0.62; 95% CI: 0.46-0.84, respectively).
FeedsMetformin×all-cause mortality

clause the extractor read what became the number

2 · Its place on the map

Where it lands on the map

Rows are treatments, columns are outcomes. The coloured squares are the cells this paper feeds, coloured by the vote it casts there. Click one to jump to what this paper adds to it.

supports the treatmentfavours the comparatorno clear differenceread, but no usable result
3 · What it changes

What it adds to each cell

For every cell the paper feeds: the belief in the claim with and without this paper, and this paper's estimate drawn against every other readable study in the cell. The ringed dot is this paper.

Metformin×all-cause mortality

No readable resultOpen on the map →What to test next →

1 readable study in this cell: 0 favour the treatment, 1 find no difference, 0 favour the comparator.

Belief with this paper
0.50one trial · 1 family supports, 0 contradict · against placebo
Without itNot a counted family in this claim, so removing it changes nothing.
← favours the treatmentfavours the comparator →
1 · no effect
NCT000387272,779 enrolled · 1996
HR 0.990.79 to 1.25

This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.

4 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

5 · Its place in the literature

Who cites it

82 citing papers in PubMed, 11 syntheses or guidelines pooled it, 155 citations in OpenAlex.

  1. Pooled it
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  7. Metformin as an adjuvant treatment for cancer: a systematic review and meta-analysis.Annals of oncology : official journal of the European Society for Medical Oncology · 2016
    Pooled it
  8. Pooled it
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  11. Pooled it
  12. Trial
  13. Phase II study of everolimus and letrozole in patients with recurrent endometrial carcinoma.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2015
    Trial
  14. Article
  15. Review
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22 more citing papers are in PubMed but not listed here.

6 · The record

Corrections and comments

7 · Who and what money

Authors and funding

4 authors at 2 institutions in 1 country.

Ming YinDepartment of Internal Medicine.
Jie Zhou
Edward J Gorak
Fahd Quddus
Geisinger Medical Center · USDanville Community College · US

Funding

No grant is acknowledged in the PubMed record.

8 · The paper itself

Abstract

The marked sentences are the ones the graph read a number from.

unlabelledPatients with type 2 diabetes have increased cancer risk and cancer-related mortality, which can be reduced by metformin treatment. However, it is unclear whether metformin can also modulate clinical outcomes in patients with cancer and concurrent type 2 diabetes. PATIENTS AND

methodsA meta-analysis of 20 publications that included 13,008 subjects was performed to investigate the association between metformin and overall survival (OS) as well as cancer-specific survival (CSS) in patients with cancer and concurrent type 2 diabetes.

resultsWe found that there was a relative survival benefit associated with metformin treatment compared with treatment with other glucose-lowering medications in both OS and CSS (hazard ratio [HR] = 0.66; 95% confidence interval [CI]: 0.55-0.79 and HR = 0.62; 95% CI: 0.46-0.84, respectively). These associations were also observed in subgroups by cancer type and country.

conclusionThese results suggest that metformin is the drug of choice in the treatment of patients with cancer and concurrent type 2 diabetes.

Indexed as

Diabetes Mellitus, Type 2HumansHypoglycemic AgentsMetforminNeoplasmsHypoglycemic AgentsMetforminCancerDiabetesMeta-AnalysisMetforminSurvival

Identifiers

PMID24258613
PMCPMC3868417
OpenAlexW2146511561

What Socratic holds

Texttitle and abstract
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.