Meta‐analysis: Chemoprevention of hepatocellular carcinoma with statins, aspirin and metformin

Abstract

Background: Emerging data suggest that statins, aspirin and metformin may protect against hepatocellular carcinoma (HCC) development. However, prior meta-analyses were limited by heterogeneity and inclusion of studies without adequate adjustment for baseline risks.Aim: To examine by an updated meta-analysis the association between these medications and HCC risk.Methods: Medline and Embase databases were searched from inception to March 2022 for studies that balanced baseline risks between study groups via propensity score matching or inverse probability of treatment weighting, that reported the impact of statins, aspirin or metformin on HCC risk. Multivariable-adjusted hazard ratios (HRs) for HCC were pooled using a random effects model. Results: Statin use was associated with reduced HCC risk overall (HR: 0.52; 95% CI: 0.37-0.72) (10 studies, 1,774,476), and in subgroup analyses for cirrhosis, hepatitis B/C, non-alcoholic fatty liver disease, studies accounting for concurrent aspirin and metformin consumption and lipophilic statins. Aspirin use was associated | 601 ZENG et al.

Letter: Association between aspirin use and risk of hepatocellular carcinoma in patients with chronic hepatitis B

“…4 According to a recent updated meta-analysis, although aspirin and statin use were associated with reduced HCC risk, only statin use was significant in subgroup analyses accounting for concurrent medications. 5 In this meta-analysis, the association between aspirin use and HCC risk persisted in fewer/none of the subgroup analyses and did not reach statistical significance in subgroup analyses that accounted for concurrent statin use. This calls for a cautious interpretation of the overall analyses of the association between aspirin and HCC risk.…”

Alcoholic Liver Disease-Related Hepatocellular Carcinoma: Characteristics and Comparison to General Slovak Hepatocellular Cancer Population

“…Moreover, there are many additional cofactors that can influence hepatocellular cancer development and survival. Published meta-analyses suggest that regular statin [ 26 ], aspirin [ 27 ] and metformin [ 28 ] can reduce the risk of hepatocellular cancer development. Some of these can even improve the overall survival of patients with diagnosed cancer [ 29 ].…”

The interplay between chronic hepatitis B and diabetes mellitus: A narrative and concise review

“…A recent meta-analysis, including cohort studies that balanced patient baseline characteristics between groups, found the protective effect of metformin was insignificant in both the overall analysis and those accounted for the use of statins, aspirin, and NSAIDs, with a notable high degree of heterogeneity observed. 37 One prominent challenge T A B L E 1 Diabetes mellitus, hyperglycemia, and insulin resistance are key components in the definition of steatotic liver disease.…”

“…The potential protective role of metformin against HCC has garnered considerable attention in the previous literature 34–36 ; however, conflicting findings have emerged, necessitating further investigation. A recent meta‐analysis, including cohort studies that balanced patient baseline characteristics between groups, found the protective effect of metformin was insignificant in both the overall analysis and those accounted for the use of statins, aspirin, and NSAIDs, with a notable high degree of heterogeneity observed 37 . One prominent challenge arises from the predominantly observational nature of the included studies, which limits the ability to establish causality.…”