Statin Use is Associated With The Reduction in Hepatocellular Carcinoma Recurrence After Liver Surgery

Abstract

Background Hepatocellular carcinoma (HCC) is the sixth most common form of cancer worldwide. Although surgical treatments have an acceptable cure rate, tumor recurrence is still a challenging issue. In this meta-analysis, we investigated whether statins prevent HCC recurrence following liver surgery. Methods PubMed, Web of Science, EMBASE and Cochrane Central were searched. The Outcome of interest was the HCC recurrence after hepatic surgery. Pooled estimates were represented as hazard ratios (HRs) and odds ratios (ORs) using a random-effects model. Summary effect measures are presented together with their corresponding 95% confidence intervals (CI). The certainty of evidence was evaluated using the Grades of Research, Assessment, Development and Evaluation (GRADE) approach. Results The literature search retrieved 1,362 studies excluding duplicates. Nine retrospective studies including 44,219 patients (2,243 in the statin group and 41,976 in the non-statin group) were included in the qualitative analysis. Patients who received statins had a lower rate of recurrence after liver surgery (HR: 0.41; 95% CI: 0.31– 0.54; p <0.001). Moreover, Statins decreased the recurrence one year after surgery (OR: 0.27; 95% CI: 0.16–0.47; P < 0.001), three years after surgery (OR: 0.22; 95% CI: 0.15–0.33; P < 0.001), and five years after surgery (OR: 0.28; 95% CI: 0.19–0.42; P < 0.001). The certainty of evidence for the outcomes was moderate. Conclusion Statins increase the disease-free survival of patients with HCC after liver surgery. These drugs seem to have chemoprevention effects that decrease the probability of HCC recurrence after liver transplantation or liver resection.

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

“…Emerging data suggest that the use of statins, aspirin and metformin may be chemoprotective against HCC. [8][9][10][11][12] However, prior meta-analyses on this topic had some limitations such as pooling odds ratios that are not time-to-event measurements, 11,[13][14][15][16] or pooling data that had not been adequately adjusted for background differences in treated versus untreated patients. There have also been several recent relevant large studies that were not included in previous meta-analyses.…”