Evidence map›Metformin × all-cause mortality›PMID 26446233›Full record

SynthesisThe oncologist2015

Metformin Use Is Associated With Better Survival of Breast Cancer Patients With Diabetes: A Meta-Analysis.

Hong Xu, Kai Chen, Xiaoyan Jia, Yali Tian, Yun Dai, Dapeng Li, Jing Xie, Min Tao, Yixiang Mao

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

Synthesis in The oncologist, 2015. The graph read 3 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 an association that does not count as treatment evidence, such as HR 0.53 (0.39 to 0.71) for all-cause mortality. Cited by 68 papers, 6 of them syntheses that pooled it.

3numbers the graph read from it
0cells of the map it votes in
68citing papers in PubMed, 6 pooled it
4.7field-weighted citation impact, top 4% 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

All-cause mortalitycomparator not stated · t2dfeeds one cell of the map
HR 0.350.15 to 0.84
Subgroup analysis revealed that metformin improved the overall survival by 65% after adjusting for hormone receptor expression (HR: 0.35; 95% CI: 0.15-0.84).
FeedsMetformin×all-cause mortality
All-cause mortalityan association or prognostic statement, not a treatment comparison · t2dfeeds one cell of the map
HR 0.890.79 to 1.00
The meta-analysis showed that metformin was associated with better overall survival times (HR: 0.53; 95% CI: 0.39-0.71) and cancer-specific survival times (HR: 0.89; 95% CI: 0.79-1.00).
FeedsMetformin×all-cause mortality
All-cause mortalityan association or prognostic statement, not a treatment comparison · t2dfeeds one cell of the map
HR 0.530.39 to 0.71
The meta-analysis showed that metformin was associated with better overall survival times (HR: 0.53; 95% CI: 0.39-0.71) and cancer-specific survival times (HR: 0.89; 95% CI: 0.79-1.00).
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

68 citing papers in PubMed, 6 syntheses or guidelines pooled it, 105 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Risk Factors for Anthracycline-Induced Cardiotoxicity.Frontiers in cardiovascular medicine · 2021
    Pooled it
  4. Pooled it
  5. 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
  6. Pooled it
  7. Trial
  8. Trial
  9. Trial
  10. Article
  11. Review
  12. Article
  13. Article
  14. Review
  15. Article
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8 more citing papers are in PubMed but not listed here.

6 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

7 · Who and what money

Authors and funding

9 authors at 3 institutions in 2 countries.

Hong XuDepartment of Oncology, First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.
Kai ChenDepartment of Oncology, First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.
Xiaoyan JiaDepartment of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Yali TianDepartment of Oncology, Suzhou Xiangcheng People's Hospital, Suzhou, People's Republic of China.
Yun DaiDepartment of Oncology, First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.
Dapeng LiDepartment of Oncology, First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.
Jing XieDepartment of Oncology, First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.
Min TaoDepartment of Oncology, First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China Jiangsu Institute of Clinical Immunology, Suzhou, People's Republic of China maoyix@gmail.com mtao@medmail.com.cn.
Yixiang MaoDepartment of Oncology, First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA Jiangsu Institute of Clinical Immunology, Suzhou, People's Republic of China maoyix@gmail.com mtao@medmail.com.cn.
First Affiliated Hospital of Soochow University · CNSoochow University · CNThe University of Texas MD Anderson Cancer Center · 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.

backgroundDiabetic patients with breast cancer receiving metformin and neoadjuvant chemotherapy have a higher pathologic complete response rate than do diabetic patients not receiving metformin, but findings on salvage treatment have been inconsistent. We performed a meta-analysis to assess the effect of adding metformin to standard therapy on the prognosis of breast cancer patients with diabetes.

methodsWe searched PubMed, Embase, Web of Science (Thomson Scientific), China Knowledge Resource Integrated Database, VIP journal integration platform, and Chinese BioMedical Literature Database from inception to January 10, 2015, without language restrictions, including references related to metformin, breast cancer, and prognosis. We performed the meta-analysis using a random-effects model, with hazard ratios (HRs) and 95% confidence intervals (95% CIs) as effect measures.

resultsA total of 11 studies consisting of 5,464 breast cancer patients with diabetes were included, comprising 2,760 patients who had received metformin and 2,704 patients who had not. The meta-analysis showed that metformin was associated with better overall survival times (HR: 0.53; 95% CI: 0.39-0.71) and cancer-specific survival times (HR: 0.89; 95% CI: 0.79-1.00). Subgroup analysis revealed that metformin improved the overall survival by 65% after adjusting for hormone receptor expression (HR: 0.35; 95% CI: 0.15-0.84). Taking metformin after the diagnosis of breast cancer was still associated with prolonged overall survival.

conclusionThe use of metformin in standard cancer therapy might improve both overall and cancer-specific survivals of diabetic patients with breast cancer. IMPLICATIONS FOR PRACTICE: Diabetic patients with breast cancer receiving metformin and neoadjuvant chemotherapy have a higher pathologic complete response rate than diabetic patients not receiving metformin, but findings on salvage treatment have been inconsistent. The meta-analysis showed that metformin was associated with better overall survival times and cancer-specific survival times. Subgroup analysis revealed that metformin improved the overall survival by 65% after adjusting for hormone receptor expression. Taking metformin after the diagnosis of breast cancer was still associated with prolonged overall survival. The findings of this study highlight the potential usage of metformin in diabetic patients with breast cancer.

Indexed as

Breast NeoplasmsDiabetes Mellitus, Type 2FemaleHumansMetforminNeoadjuvant TherapyPrognosisSurvival AnalysisMetforminBreast cancerDiabetes mellitusMeta-analysisMetforminSurvival

Identifiers

PMID26446233
PMCPMC4718443
OpenAlexW2163702740

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.