Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, 17 Syujhou Rd, Taipei 10055, Taiwan.
J Clin Oncol. 2012 Feb 20;30(6):623-30. doi: 10.1200/JCO.2011.36.0917. Epub 2012 Jan 23.
Statins have potential protective effects against cancers, but no studies have focused on patients with chronic hepatitis B virus (HBV) infection. The purpose of this study was to investigate the association between the use of statins in HBV-infected patients and the risk of hepatocellular carcinoma (HCC).
We conducted a population-based cohort study from the Taiwan National Health Insurance Research Database. A total of 33,413 HBV-infected patients were included as the study cohort. Each patient was individually tracked from 1997 to 2008 to identify incident cases of HCC since 1999. Subsequent use of statin, other lipid-lowering agents, aspirin, and angiotensin-converting enzyme inhibitors was identified. Cox proportional hazards regression was used to calculate the hazard ratios (HRs) and 95% CIs for the association between the use of statins and the occurrence of HCC in the HBV-infected cohort.
There were 1,021 HCCs in the HBV cohort during the follow-up period of 328,946 person-years; the overall incidence rate was 310.4 HCCs per 100,000 person-years. There was a dose-response relationship between statin use and the risk of HCC in the HBV cohort. The adjusted HRs were 0.66 (95% CI, 0.44 to 0.99), 0.41 (95% CI, 0.27 to 0.61), and 0.34 (95% CI, 0.18 to 0.67) for statin use of 28 to 90, 91 to 365, and more than 365 cumulative defined daily doses (cDDDs), respectively, relative to no statin use (< 28 cDDDs).
Statin use may reduce the risk for HCC in HBV-infected patients in a dose-dependent manner. Further mechanistic research is needed.
他汀类药物对癌症具有潜在的保护作用，但目前还没有研究关注慢性乙型肝炎病毒（HBV）感染患者。本研究旨在探讨 HBV 感染患者使用他汀类药物与肝细胞癌（HCC）风险之间的关系。
我们进行了一项基于人群的队列研究，数据来自台湾全民健康保险研究数据库。共纳入 33413 例 HBV 感染患者作为研究队列。自 1997 年至 2008 年，每位患者均接受个体随访，以确定自 1999 年以来 HCC 的发病情况。随后确定他汀类药物、其他降脂药物、阿司匹林和血管紧张素转换酶抑制剂的使用情况。使用 Cox 比例风险回归计算他汀类药物使用与 HBV 感染队列 HCC 发生之间的关联的风险比（HR）和 95%置信区间（CI）。
在 328946 人年的随访期间，HBV 队列中发生了 1021 例 HCC，总发病率为每 100000 人年 310.4 例。HBV 队列中他汀类药物使用与 HCC 风险之间存在剂量反应关系。调整后的 HR 分别为 0.66（95%CI，0.44 至 0.99）、0.41（95%CI，0.27 至 0.61）和 0.34（95%CI，0.18 至 0.67），他汀类药物使用量为 28 至 90、91 至 365 和超过 365 个累积定义日剂量（cDDD），与未使用他汀类药物（<28 cDDD）相比。
他汀类药物的使用可能与剂量依赖的方式降低 HBV 感染患者 HCC 的风险。需要进一步的机制研究。
