PMN-MDSC accumulation regulated by metformin. (A) Paired analysis of PMN-MDSC frequency in peripheral blood and tumor tissues. (B) Clinical characteristics of eight patients showing higher PMN-MDSC frequency in peripheral blood than in tumor samples. (C) Comparative analysis of PMN-MDSC distribution in patients with ESCC treated with metformin. Results presented as ratio between tumor-infiltrating and circulating MDSCs. Expression of CD33 (D), Arg-1, iNOS, and NOX (E) in tumor tissues from patients treated with metformin was measured using qRT-PCR. (F) CD33 expression in tumor samples was analyzed using immunohistochemistry. (G) Overall survival of patients with ESCC, with or without diabetes, treated or not-treated with metformin shown as a Kaplan-Meier curve. Statistical significance determined by a log-rank test. *P < 0.05; **P < 0.01.