A Systematic Review and Meta-Analysis of the Significance of Diabetes on Kidney Cancer Outcomes and the Role of Metformin
Abstract
Background and objectives: The effect of diabetes and metformin on renal cell carcinoma (RCC) outcomes has not been well established.
Methods: A systematic review and meta-analysis were performed to investigate the influence of diabetes on various outcome measures in renal cell carcinoma (RCC). We have also investigated the effect of metformin as a potential strategy to improve prognosis. A computerized systematic search of Medline, Embase, ProQuest, PubMed, and Google Scholar for literature was performed between its inception and September 2024 according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.
Results: A total of 41 published studies were included in the analysis. Patients without diabetes were associated with improved RCC-specific survival (hazard ratios [HR] 1.38, 95% confidence intervals [CI], 1.23-1.55), progression-free survival (HR 1.61, 95% CI, 1.26-2.07), and overall survival (HR 1.51, 95% CI, 1.34-1.70) compared to patients with diabetes. Among patients with diabetes, metformin use was associated with more favorable survival outcomes; however, these findings are observational and are subject to time-related biases. Key limitations included observational study design, substantial heterogeneity, limited reporting on diabetes severity and glycemic control, and a high likelihood of time-related and indication biases, including immortal time bias.
Conclusions: This largest systematic review demonstrates that diabetes mellitus is…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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