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Meta-Analysis
. 2018 Jan 10;18(1):65.
doi: 10.1186/s12885-017-3934-9.

Metformin, Asian ethnicity and risk of prostate cancer in type 2 diabetes: a systematic review and meta-analysis

Christopher B Chen  1 , Maxim Eskin  1 , Dean T Eurich  1 , Sumit R Majumdar  2 , Jeffrey A Johnson  3   4
Affiliations
Meta-Analysis

Metformin, Asian ethnicity and risk of prostate cancer in type 2 diabetes: a systematic review and meta-analysis

Christopher B Chen et al. BMC Cancer. .

Abstract

Background: Metformin is associated with a reduced risk of some cancers but its effect on prostate cancer is unclear. Some studies suggest only Asians derive this benefit. Therefore, we undertook a systematic review with particular attention to ethnicity.

Methods: Medline, Embase, Scopus, Web of Science, and EBM Reviews were searched from inception to 2015. Two reviewers identified and abstracted articles. Studies were pooled using random effects model and stratified by Western- vs Asian-based populations.

Results: We identified 482 studies; 26 underwent full review. Of Western-based studies (n = 23), two were randomized trials and 21 were observational studies. All Asian-based studies (n = 3) were observational. There were 1,572,307 patients, 1,171,643 Western vs 400,664 Asian. Across all studies there was no association between metformin and prostate cancer (RR: 1.01, 95%CI: 0.86-1.18, I2: 97%), with similar findings in Western-based trials (RR: 1.38, 95%CI: 0.72-2.64 I2: 15%) and observational studies (RR: 1.03 95%CI: 0.94-1.13, I2: 88%). Asian-based studies suggested a non-significant reduction (RR: 0.75, 95%CI: 0.42-1.34, I2: 90%), although these results were highly influenced by one study of almost 400,000 patients (propensity-adjusted RR: 0.47 95%CI 0.45-0.49). Removing this influential study yielded an estimate more congruent with Western-based studies (RR: 0.98 95%CI:0.71-1.36, I2: 0%).

Conclusion: There is likely no association between metformin and risk of prostate cancer, in either Western-based or Asian-based populations after removing a highly influential Asian-based study.

Keywords: Ethnicity & prostate cancer; Metformin.

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Figures

Fig. 1
Fig. 1
Current Metformin Use Vs. No Current Metformin Use in Western-Based Observational Studies
Fig. 2
Fig. 2
Current Metformin Use Vs. No Current Metformin Use in Western-Based Randomized Trials
Fig. 3
Fig. 3
Current Metformin Use Vs. No Current Metformin Use in Asian-Based Observational Studies
See this image and copyright information in PMC

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