The Prognostic Effect of Statin Use on Urologic Cancers

Luo, Yilun; She, Dong-Li; Xiong, Hu; Fu, Shengjun; Yang, Li

doi:10.1097/md.0000000000001523

Cited by 17 publications

(9 citation statements)

References 55 publications

(33 reference statements)

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“…We identified observational studies included in the most recently published meta-analyses of statin use in patients with prostate, breast, colorectal, or urological cancer . Eligible studies for our analysis reported HRs, or other measures of relative risk, of cancer-specific mortality or all-cause mortality for statin vs no statin use among patients with stages I to III cancer followed up from time of cancer diagnosis.…”

Section: Methodsmentioning

confidence: 99%

“…We identified observational studies included in the most recently published meta-analyses of statin use in patients with prostate, 1 breast, 2 colorectal, 3 or urological cancer. 20 Eligible studies for our analysis reported HRs, or other measures of rela-tive risk, of cancer-specific mortality or all-cause mortality for statin vs no statin use among patients with stages I to III cancer followed up from time of cancer diagnosis. Because of substantial heterogeneity across studies, these relative risk estimates cannot be pooled using a fixed-effect approach.…”

Section: Comparison With Previous Observational Studiesmentioning

confidence: 99%

“…Observational Studies of Statins and Mortality Among Patients With Cancer Included in Recent Meta-analyses[1][2][3]20 Statin Users vs Nonusers During Follow-up (Risk of Immortal-Time Bias)…”

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confidence: 99%

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Examining Bias in Studies of Statin Treatment and Survival in Patients With Cancer

et al. 2018

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Importance Cancer patients who use statins appear to have a substantially better survival than non-users in observational studies. However, this inverse association between statin use and mortality in cancer patients may be due to selection bias and immortal time bias. Objective We used observational data to emulate a randomized trial of statin initiation that is free of selection bias and immortal time bias. Design We used data on 17,372 cancer patients from the SEER-Medicare 2007-2009 database with complete follow-up until 2011. Individuals were duplicated, with each replicate assigned to either the strategy “statin initiation within 6 months of diagnosis” or “no statin initiation”. Replicates were censored when they stopped following their assigned strategy, and the potential selection bias was adjusted for via inverse-probability weighting. Hazard ratios (HR), cumulative incidences, and risk differences were calculated for all-cause mortality and cancer-specific mortality. We then compared our estimates with those obtained using the same analytic approaches as in previous observational studies. Setting The SEER-Medicare data is a linkage between 17 American cancer registries and claims files from Medicare and Medicaid in 12 states. Participants We included individuals with a new diagnosis of colorectal, breast, prostate, and bladder cancer who had not been prescribed statins for at least 6 months before cancer. Exposure Statin initiation within 6 months from cancer diagnosis. Main outcome measure Cancer-specific and all-cause mortality. Results The adjusted HR (95% CI) comparing statin initiation vs. no initiation was 1.00 (0.88-1.15) for cancer-specific mortality and 1.07 (0.93-1.21) for overall mortality. Cumulative incidence curves for each group were almost overlapping. On the contrary, the methods used by prior studies resulted in a strong inverse association between statin use and mortality. Conclusion and relevance After using methods that are not susceptible to selection bias from prevalent users and to immortal time bias, initiation of statins within 6 months of cancer diagnosis did not appear to improve 3-year cancer-specific or overall survival.

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Section: Methodsmentioning

confidence: 99%

Section: Comparison With Previous Observational Studiesmentioning

confidence: 99%

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Examining Bias in Studies of Statin Treatment and Survival in Patients With Cancer

et al. 2018

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“…136 duplicate articles were initially excluded, and an additional 35 articles were screened by title. Another 102 articles were excluded after assessing the abstract, and 46 articles were finally excluded after full-text screening and finally, 16 eligible meta-analyses reporting various kinds of cancer mortality or survival in 11 cancers were finally selected for re-analysis ( Figure 1) [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]. Overall, all-cause mortality was reported as outcomes in 11 cancer types, cancer-specific mortality in 8 cancer types, recurrence-free survival in 5 cancer types, progression-free survival in 4 cancer types and disease-free survival in one cancer type (Tables 1-4).…”

Section: Search Strategy For the Literature And Included Studies For mentioning

confidence: 99%

Statin and Cancer Mortality and Survival: An Umbrella Systematic Review and Meta-Analysis

Jeong

Lee

Kim

et al. 2020

JCM

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The aim of this study is to provide an overview and understand the strength of evidence and the extent of potential biases and the validity of claimed associations between the use of statins and cancer mortality or survival. We performed a comprehensive umbrella review of meta-analyses and systematically appraised the relevant meta-analyses of observational studies on the associations between statin use and cancer mortality or survival in various kinds of cancer. We searched the PubMed database and screened the reference list of relevant articles. We obtained the summary effect, 95% confidence interval, heterogeneity, and also examined small study effects and 95% prediction intervals for effect sizes, and the level of evidence was determined from the criteria. Regarding cancer mortality, statin use showed convincing evidence for an association with a reduced cancer-specific mortality rate for colorectal cancer. Four associations with reduced all-cause mortality (for breast cancer, colorectal cancer, endocrine-related gynecological cancer, and ovarian cancer) had a suggestive evidence. Moreover, analyses in nine cancers showed a weak level of evidence, while the remaining 15 did not indicate significant changes in either direction. Although there was a preventive effect of statin on cancer mortality in some cancer types, the evidence supporting the use of statins to reduce cancer mortality or survival was low.

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“…To the best of our knowledge, there are three meta-analyses which evaluated the association between statin use and prognosis in patients with RCC. An early meta-analysis published in 2015 showed that statin use may improve the OS in patients with RCC, while other outcomes, such as PFS or CSS were not significantly affected ( 39 ). The authors therefore concluded that although a benefit of statin on survival was suggested, this may not be related to the anticancer efficacy of statin because outcomes related to the tumor progression was not significantly affected ( 39 ).…”

Section: Discussionmentioning

confidence: 99%

Influence of statin use on prognosis of patients with renal cell cancer: a meta-analysis

et al. 2023

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BackgroundStatin may confer anticancer efficacy, while the studies evaluating the influence of statin on survival of patients with renal cell cancer (RCC) yielded inconsistent results. A systematic review and meta-analysis was performed to investigate the association between statin use and survival of patients with RCC.Materials and MethodsCohort studies were identified by search of PubMed, Embase, and Web of Science databases according to the objective of the meta-analysis. A random-effect model incorporating the possible between-study heterogeneity was used for meta-analysis. Subgroup analyses according to study characteristics were also performed.ResultsSeventeen cohort studies involving 42528 patients with RCC were available for the meta-analysis. Results showed that statin use was associated with a better overall survival (OS, hazard ratio [HR]: 0.73, 95% confidence interval [CI]: 0.65 to 0.84, p < 0.001; I2 = 40%), progression progression-free survival (PFS, HR: 0.82, 95% CI: 0.68 to 0.98, p = 0.03; I2 = 52%), and cancer-specific survival (CSS, HR: 0.76, 95% CI: 0.59 to 0.99, p = 0.04; I2 = 38%). Besides, for the outcome of OS and PFS, subgroup analyses showed similar results in patients with surgical and non-surgical anticancer treatments, and in patients with stage I-III and stage IV RCC (p values for subgroup difference all > 0.05).ConclusionsStatin use may be associated with improved survival outcomes in patients with RCC. Although prospective clinical studies should be considered to validate these results, these findings suggest that statins may be potential adjuvant therapy for patients with RCC.

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The Prognostic Effect of Statin Use on Urologic Cancers

Cited by 17 publications

References 55 publications

Examining Bias in Studies of Statin Treatment and Survival in Patients With Cancer

Examining Bias in Studies of Statin Treatment and Survival in Patients With Cancer

Statin and Cancer Mortality and Survival: An Umbrella Systematic Review and Meta-Analysis

Influence of statin use on prognosis of patients with renal cell cancer: a meta-analysis

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