Suitable Liquid Biopsy Samples for Detecting Kras Mutations in Patients with Pancreatic Cancer

the meta-analysis.The primary endpoint of interest was overall survival assessed by hazard ratio.The pooled hazard ratio (HR) and 95% confidence intervals (CI) were calculated from the original study data by using the Mantel-Haenszel method (fixed effects model).Statistical heterogeneity was assessed using the forest plot and inconsistency statistic (I-squared).If any heterogeneity existed (I-squared > 50%), it was to be explored by subgroup analyses, meta-regression and sensitivity analyses.Results: A total of seven retrospective cohort studies, involving 3,807 pre-existing diabetic patients with PAC were included.Across studies, mean age was seventy-five years old and 49% of the patients were men.Sixty-one percent had BMI<25 and 86% of patients had ECOG score of 0-1 whereas the remaining had scores 2 or greater.Among the studies, thirty-five percent had either resectable or locally advanced disease and the remaining 65% had either unresectable or metastatic disease.Administration of metformin to pre-existing diabetic patients with PAC reduced the risk of overall mortality by 19% (HR 0.81, 95% Cl 0.75-0.86)when compared to those not taking metformin.Isquare of the study was 48.8%, which was below 50% indicting statistical homogeneity among the studies.Conclusions: Metformin exposure when compared to non-exposure is associated with an increase in overall survival in pre-existing diabetic patients diagnosed with PAC.Further randomized, controlled trials looking at the use of metformin in preexisting diabetic patients with resectable and locally advanced PAC are needed.