Statin use associated with improved overall and cancer specific survival in patients with head and neck cancer

Abstract

Objectives: Studies have shown the utility of lipid-lowering agents in improving outcomes in various cancers. We aim to explore how statins affect overall survival and cancer specific survival in head and neck cancer patients using population-based datasets. Patients and methods: Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked dataset, we separated HNC patients into three groups: those with no hyperlipidemia (nH), those with hyperlipidemia and not taking a statin (HnS), and those with hyperlipidemia and taking a statin (H + S). Overall survival (OS) and cancer specific survival (CSS) were compared between the three groups based on disease subsite (oral cavity, oropharynx, and other) using Kaplan-Meier and multivariate Cox regression analysis (MVA), controlling for demographic, socioeconomic, staging, treatment, and comorbidity covariates. Using Pearson chi-square analysis, we also compared the incidence of cancer-related toxicity events. Results: There were 495 nH, 567 HnS, and 530 H + S patients. H + S patients had superior OS and CSS (73.0, 81.2%) relative to nH (58.6, 69.1%) and HnS groups (61.7, 69.2%) (p < 0.01). On MVA, H + S patients showed improved OS (p < 0.01) and CSS (p = 0.04) compared to nH (HR = 1.64, 1.56) and HnS (HR = 1.40, 1.37). MVA stratified by subsite yielded similar results for oral cavity and oropharyngeal disease. Toxicity-related events did not differ significantly between the groups. Conclusion: HNC patients with hyperlipidemia and taking a statin demonstrated improved outcomes compared to nH and HnS patients, further supporting statins’ role as a potential adjuvant anti-neoplastic agent in HNC. Further prospective studies to investigate the impact of statins on HNC outcomes are warranted.

Statin use and head and neck squamous cell carcinoma outcomes

“…Importantly, neither of these previous studies adjusted for BMI in their analyses. 14,15 Higher BMI has been found to be protective against adverse HNSCC outcomes. [21][22][23] Furthermore, according to the American College of Cardiology and the American Heart Association, obesity is a risk factor for developing heart disease and statin use is recommended for people who are at "borderline or intermediate risk"…”

“…11,12 The few studies that have investigated this association found a protective association between statin use and the development of HNSCC as well as a protective association between the use of statins and overall death and HNSCC-specific death. [13][14][15] Although these analyses provide promising results, they had some important limitations. First, they did not adjust for some important confounding variables in their models, notably characteristics such as BMI.…”

Statins: Epidrugs with effects on endothelial health?

“…Being established that epigenetic mechanisms play an essential role in cellular development and function, data collected in the past few years revealed that many of pleiotropic properties of statins are mediated by epigenetic mechanisms 15 . Furthermore, those ‘non‐classical’ effects are not limited to CV field but they would extend to other conditions such as malignancies 63,64 . However, as those mechanisms are revealed, their complexity is becoming even more evident and the exact underlying molecular mechanisms are far from being clarified.…”

“…15 Furthermore, those 'non-classical' effects are not limited to CV field but they would extend to other conditions such as malignancies. 63,64 However, as those mechanisms are revealed, their complexity is becoming even more evident and the exact underlying molecular mechanisms are far from being clarified. Hence, additional evidence from prospective studies will be necessary to improve knowledge on the impact of statins on epigenetic markers and whether epigenetic effects mediated by statins contribute to statins' lipid-lowering and pleiotropic effects.…”

Comparing serum protein levels can aid in differentiating HPV-negative and -positive oropharyngeal squamous cell carcinoma patients

“…ApoF is a sialoglycoprotein, also known as "lipid transfer inhibitor protein", and is an inhibitor of cholesterol ester transferase that binds to LDL, and regulates cholesterol transport [36]. Lipid metabolic reprogramming is a known hallmark of cancer, and it has been shown that inhibition of cholesterol production with statins in head and neck cancers is associated with improved disease-specific survival [37]. In animal studies, ApoF has also been associated with immune and inflammation responses [38].…”