Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21205, USA.
J Urol. 2011 Apr;185(4):1268-73. doi: 10.1016/j.juro.2010.11.089. Epub 2011 Feb 22.
Prospective studies suggest that statins protect against advanced stage and possibly high grade prostate cancer. However, few studies have investigated the influence of stains on outcomes in men with prostate cancer. Thus, we evaluated the association of statin use with pathological tumor characteristics and prostate cancer recurrence after prostatectomy in a retrospective cohort.
A total of 2,399 patients of 1 surgeon at Johns Hopkins Hospital who underwent radical prostatectomy in 1993 to 2006 and had not previously received hormone or radiation therapy were followed for recurrence. The surgeon routinely asked during the preoperative consultation what medications the men were using. Additional information on statin use was obtained from a mailed survey. We estimated the association of statin use with nonorgan confined disease (pT3a/b or N1) and high grade disease (Gleason sum [4 + 3] or greater) using logistic regression (OR), and recurrence using Cox proportional hazards regression (HR).
The 16.1% of men who used a statin at prostatectomy were statistically significantly less likely to have nonorgan confined disease than nonusers (OR 0.66, 95% CI 0.50-0.85). Statin use was inversely associated with high grade disease only in men with preoperative PSA 10 ng/ml or greater (OR 0.35, 95% CI 0.13-0.93, p-interaction = 0.02). The HR of recurrence among men who used a statin for 1 year or greater compared to nonusers was 0.77 (95% CI 0.41-1.42).
Our findings support the hypothesis that statin use may protect against prostate cancer with poorer pathological characteristics. We could not rule in or out that longer term statin use may protect against recurrence after prostatectomy.
前瞻性研究表明，他汀类药物可预防晚期和可能的高级别前列腺癌。然而，很少有研究调查他汀类药物对前列腺癌患者的肿瘤结局的影响。因此，我们评估了在回顾性队列中他汀类药物使用与前列腺癌根治术后病理肿瘤特征和前列腺癌复发的相关性。
共有 2399 名在约翰霍普金斯医院接受根治性前列腺切除术的外科医生的患者，这些患者于 1993 年至 2006 年期间未接受激素或放疗，随访前列腺癌复发情况。外科医生在术前咨询时常规询问患者使用的药物。通过邮寄调查获得关于他汀类药物使用的其他信息。我们使用逻辑回归（OR）估计他汀类药物使用与非器官受限疾病（pT3a / b 或 N1）和高级别疾病（Gleason 总和[4 + 3]或更高）之间的相关性，并使用 Cox 比例风险回归（HR）估计复发的相关性。
在前列腺癌手术中使用他汀类药物的 16.1%的男性与非使用者相比，患有非器官受限疾病的可能性明显降低（OR 0.66，95%CI 0.50-0.85）。仅在术前 PSA 为 10ng/ml 或更高的男性中，他汀类药物的使用与高级别疾病呈负相关（OR 0.35，95%CI 0.13-0.93，p 交互作用= 0.02）。与非使用者相比，使用他汀类药物 1 年或以上的男性的复发 HR 为 0.77（95%CI 0.41-1.42）。
我们的研究结果支持他汀类药物使用可能预防具有较差病理特征的前列腺癌的假说。我们不能排除长期使用他汀类药物可能预防前列腺癌手术后的复发。
