Bonovas Stefanos, Filioussi Kalitsa, Flordellis Christodoulos S, Sitaras Nikolaos M
Department of Pharmacology, School of Medicine, University of Athens, Athens 11527, Greece.
J Clin Oncol. 2007 Aug 10;25(23):3462-8. doi: 10.1200/JCO.2007.10.8936.
Statins have been suggested to prevent colorectal cancer. Several epidemiologic studies have evaluated this association, whereas randomized controlled trials (RCTs) on cardiovascular outcomes provide relevant data as a secondary end point. Our aim was to examine the strength of this association through a detailed meta-analysis of the studies published on the subject in peer-reviewed literature.
A comprehensive search for studies published up to December 2006 was performed, reviews of each study were conducted, and data were abstracted. Before meta-analysis, the studies were evaluated for publication bias and heterogeneity. Pooled relative risk (RR) estimates with 95% CIs were calculated using the fixed- and random-effects models.
Eighteen studies involving more than 1.5 million participants contributed to the analysis. They were grouped on the basis of study design, and separate meta-analyses were conducted. There was no evidence of an association between statin use and risk of colorectal cancer either among RCTs (RR = 0.95; 95% CI, 0.80 to 1.13; n = 6) or among cohort studies (RR = 0.96; 95% CI, 0.84 to 1.11; n = 3). However, statin use was associated with a modest reduction in the risk of colorectal cancer among case-control studies (RR = 0.91; 95% CI, 0.87 to 0.96; n = 9). Low evidence of publication bias or heterogeneity was found.
Our meta-analysis results do not support the hypothesis that statins strongly reduce the risk of colorectal cancer, when taken for management of hypercholesterolemia. However, we cannot rule out a modest reduction in risk or an effect associated with higher doses of statins.
他汀类药物被认为可预防结直肠癌。多项流行病学研究评估了这种关联，而关于心血管结局的随机对照试验（RCT）则提供了作为次要终点的相关数据。我们的目的是通过对同行评审文献中发表的关于该主题的研究进行详细的荟萃分析，来检验这种关联的强度。
对截至2006年12月发表的研究进行全面检索，对每项研究进行综述，并提取数据。在进行荟萃分析之前，对研究进行发表偏倚和异质性评估。使用固定效应模型和随机效应模型计算合并相对风险（RR）估计值及其95%置信区间（CI）。
18项涉及超过150万参与者的研究纳入了分析。根据研究设计进行分组，并分别进行荟萃分析。在随机对照试验（RR = 0.95；95% CI，0.80至1.13；n = 6）或队列研究（RR = 0.96；95% CI，0.84至1.11；n = 3）中，均未发现他汀类药物使用与结直肠癌风险之间存在关联。然而，在病例对照研究中，他汀类药物的使用与结直肠癌风险适度降低相关（RR = 0.91；95% CI，0.87至0.96；n = 9）。发现存在低水平的发表偏倚或异质性证据。
我们的荟萃分析结果不支持他汀类药物用于治疗高胆固醇血症时能显著降低结直肠癌风险的假设。然而，我们不能排除风险有适度降低或与高剂量他汀类药物相关的效应。
