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Richard PO, Ahmad AE, Bashir S, et al. Impact of oral hypoglycemic agents on mortality among diabetic patients with non-muscle-invasive bladder cancer: A populationbased analysis. Can Urol Assoc J. 2018;12(6):203-210doi: 10.5489/cuaj.4870.
Richard, P. O., Ahmad, A. E., Bashir, S., Zlotta, A., Bhindi, B., Leao, R., Nayan, M., Mohammed, A., Fleshner, N. E., & Kulkarni, G. S. (2018). Impact of oral hypoglycemic agents on mortality among diabetic patients with non-muscle-invasive bladder cancer: A populationbased analysis. Canadian Urological Association journal = Journal de l'Association des urologues du Canada, 12(6), 203-210. https://doi.org/10.5489/cuaj.4870
Richard, Patrick O, et al. "Impact of oral hypoglycemic agents on mortality among diabetic patients with non-muscle-invasive bladder cancer: A populationbased analysis." Canadian Urological Association journal = Journal de l'Association des urologues du Canada vol. 12,6 (2018): 203-210. doi: https://doi.org/10.5489/cuaj.4870
Richard PO, Ahmad AE, Bashir S, Zlotta A, Bhindi B, Leao R, Nayan M, Mohammed A, Fleshner NE, Kulkarni GS. Impact of oral hypoglycemic agents on mortality among diabetic patients with non-muscle-invasive bladder cancer: A populationbased analysis. Can Urol Assoc J. 2018 Jun;12(6):203-210. doi: 10.5489/cuaj.4870. Epub 2018 Feb 23. PMID: 29485035; PMCID: PMC5994977.
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Can Urol Assoc J. 2018 Jun;12(6):203-210. doi: 10.5489/cuaj.4870. Epub 2018 Feb 23.

Impact of oral hypoglycemic agents on mortality among diabetic patients with non-muscle-invasive bladder cancer: A populationbased analysis.

Canadian Urological Association journal = Journal de l'Association des urologues du Canada

Patrick O Richard, Ardalan E Ahmad, Shaheena Bashir, Alexandre Zlotta, Bimal Bhindi, Ricardo Leao, Madhur Nayan, Aza Mohammed, Neil E Fleshner, Girish S Kulkarni

Affiliations

  1. Division of Urology, Departments of Surgery, Centre Hospitalier Universitaire de Sherbrooke and Centre de Recherche du CHUS, Sherbrooke, QC; Canada.
  2. Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON; Canada.
  3. Division of Urology, Departments of Surgery, Mount Sinai Hospital and the University of Toronto, Toronto, ON; Canada.
  4. Institute for Clinical Evaluative Sciences, Toronto, ON; Canada.

PMID: 29485035 PMCID: PMC5994977 DOI: 10.5489/cuaj.4870

Abstract

INTRODUCTION: Non-muscle-invasive bladder cancer (NMIBC) accounts for 75-85% of all urothelial bladder cancers (UBC). Many UBC patients are also afflicted by diabetes mellitus (DM). It has been postulated that several oral hypoglycemic agents could impact disease-specific survival (DSS), but the data are sparse among NMIBC patients. Our primary objective was to evaluate the impact of metformin on DSS and overall survival (OS) in NMIBC patients.

METHODS: This is a retrospective, population-based study that used linked administrative databases to identify diabetic patients ≥66 years who were subsequently diagnosed with NMIBC in Ontario between 1992 and 2012. Cumulative use of metformin and other hypoglycemic agent were calculated before and after NMIBC diagnosis. DSS and OS were estimated using multivariable competing risk and Cox proportional hazards models, respectively.

RESULTS: A total of 1742 subjects were included in the study. After a median followup of 5.2 years, 1122 (64%) had died, including 247 (15%) deaths as a result of UBC. On multivariable analysis, cumulative duration of metformin use after NMIBC diagnosis did not appear to impact DSS (hazard ratio [HR] 1.1; 95% confidence interval [CI] 0.92-1.2), whereas glyburide use appeared to have a detrimental effect (HR 1.17; 95% CI 1.02-1.3). None of the other hypoglycemic agents had an impact on OS.

CONCLUSIONS: In this large, population-based study, we have provided further evidence that metformin use does not significantly impact DSS among diabetic patients diagnosed with NMIBC. However, our findings demonstrate that glyburide use inversely affects DSS. The detrimental effect of glyburide on DSS will require further validation.

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