Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
Clin Gastroenterol Hepatol. 2013 Jun;11(6):620-9. doi: 10.1016/j.cgh.2012.12.036. Epub 2013 Jan 26.
BACKGROUND & AIMS: The incidence of esophageal cancer is increasing in the United States, especially among patients with Barrett's esophagus (BE). Statins might prevent this cancer. We performed a systematic review with a meta-analysis of studies that evaluated the effect of statins on the risk of esophageal cancer.
We conducted a systematic search of Medline, Embase, and Web of Science through August 2012. Studies were included if they evaluated exposure to statins, reported the development of esophageal cancer, and reported relative risks or odds ratios (OR), or provided data for their estimation. Summary OR estimates with 95% confidence intervals (CI) were calculated using the random-effects model. The analysis included 13 studies (including a post hoc analysis of 22 randomized controlled trials) reporting 9285 cases of esophageal cancer among 1,132,969 patients.
A meta-analysis of the studies showed a significant (28%) reduction in the risk of esophageal cancer among patients who took statins (adjusted OR, 0.72; 95% CI, 0.60-0.86), although there was considerable heterogeneity among studies. In analyzing a subset of patients known to have BE (5 studies, 312 esophageal adenocarcinomas [EAC] developed in 2125 patients), statins were associated with a significant (41%) decrease in the risk of EAC, after adjusting for potential confounders (adjusted OR, 0.59; 95% CI, 0.45-0.78) with consistent results among all studies. The number needed to treat with statins to prevent 1 case of EAC in patients with BE was 389.
Based on meta-analysis of observational studies, statin use may be associated with lower risk of esophageal cancer, particularly risk of EAC in patients with BE.
在美国，食管癌的发病率正在上升，尤其是在 Barrett 食管（BE）患者中。他汀类药物可能预防这种癌症。我们进行了一项系统评价和荟萃分析，评估了他汀类药物对食管癌风险的影响。
我们通过 Medline、Embase 和 Web of Science 系统地检索了截至 2012 年 8 月的文献。如果研究评估了他汀类药物的暴露情况、报告了食管癌的发生情况，并报告了相对风险或比值比（OR），或者提供了估计数据，则纳入研究。使用随机效应模型计算汇总 OR 估计值及其 95%置信区间（CI）。该分析包括 13 项研究（包括对 22 项随机对照试验的事后分析），共报告了 1132969 例患者中有 9285 例食管癌。
对这些研究的荟萃分析显示，服用他汀类药物的患者食管癌风险显著降低（28%）（校正 OR，0.72；95%CI，0.60-0.86），尽管研究之间存在很大的异质性。在分析已知患有 BE 的患者亚组（5 项研究，2125 例患者中有 312 例食管腺癌[EAC]发生）时，他汀类药物与 EAC 风险显著降低（41%）相关，调整了潜在混杂因素后（校正 OR，0.59；95%CI，0.45-0.78），所有研究的结果一致。在 BE 患者中，使用他汀类药物预防 1 例 EAC 的需要治疗人数为 389。
基于观察性研究的荟萃分析，他汀类药物的使用可能与食管癌风险降低相关，特别是在 BE 患者中 EAC 的风险降低。
