Norwich Medical School, University of East Anglia, Norwich, United Kingdom; Department of Gastroenterology, Norfolk & Norwich University Hospital, Norwich, United Kingdom.
Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
Gastroenterology. 2014 Mar;146(3):661-8. doi: 10.1053/j.gastro.2013.11.046. Epub 2013 Dec 6.
BACKGROUND & AIMS: Most patients with esophageal adenocarcinoma (EAC) or squamous cell cancer (ESCC) present with advanced, incurable disease. Statins have reported anti-carcinogenic effects and may be chemoprotective. We investigated the association between regular use of statins and the main histologic subtypes of esophageal malignancy (EAC, esophagogastric junctional adenocarcinoma, and ESCC) in the UK general population.
We identified all individuals in the UK General Practice Research Database diagnosed with esophageal cancer from 2000 through 2009. Patients were linked to the National Cancer Registry to confirm histologic subtypes. Each patient was matched with up to 4 controls for age, sex, and practice. We performed a nested case-control analysis using conditional logistic regression to estimate the risk of each subtype with regular statin use, adjusted for body mass index, smoking, alcohol intake, and concomitant use of medications.
In total, 581 participants with EAC, 213 with esophagogastric junctional adenocarcinoma, and 332 with ESCC were matched to 2167, 783, and 1242 controls, respectively. Regular statin use was inversely associated with development of EAC (odds ratio = 0.58; 95% confidence interval: 0.39-0.87) (with significant dose and duration responses) and esophagogastric junctional adenocarcinoma (odds ratio = 0.29; 95% confidence interval: 0.09-0.92) (with high-dose use only). Statin use for 1-4 years was inversely associated with ESCC (odds ratio = 0.51; 95% confidence interval: 0.27-0.98).
In a nested case-control analysis of a UK population-based cohort, statin use was inversely associated with histologic subtypes of esophageal cancer. Randomized controlled trials are warranted to determine whether statins have chemopreventive effects in high-risk groups.
大多数食管腺癌（EAC）或鳞状细胞癌（ESCC）患者表现为晚期、不可治愈的疾病。他汀类药物具有报道的抗癌作用，并且可能具有化学预防作用。我们研究了他汀类药物的常规使用与英国普通人群中食管恶性肿瘤（EAC、食管胃交界腺癌和 ESCC）的主要组织学亚型之间的关系。
我们在 2000 年至 2009 年期间从英国普通实践研究数据库中确定了所有诊断为食管癌的个体。患者与国家癌症登记处相关联以确认组织学亚型。每个患者与最多 4 名年龄、性别和实践相匹配的对照进行匹配。我们使用条件逻辑回归进行嵌套病例对照分析，以估计每种亚型在常规使用他汀类药物时的风险，调整了体重指数、吸烟、饮酒和同时使用药物。
共有 581 名 EAC 患者、213 名食管胃交界腺癌患者和 332 名 ESCC 患者分别与 2167 名、783 名和 1242 名对照相匹配。他汀类药物的常规使用与 EAC 的发生呈负相关（比值比=0.58；95%置信区间：0.39-0.87）（存在剂量和持续时间的显著反应）和食管胃交界腺癌（比值比=0.29；95%置信区间：0.09-0.92）（仅高剂量使用）。他汀类药物使用 1-4 年与 ESCC 呈负相关（比值比=0.51；95%置信区间：0.27-0.98）。
在英国基于人群队列的嵌套病例对照分析中，他汀类药物的使用与食管癌症的组织学亚型呈负相关。需要进行随机对照试验以确定他汀类药物是否对高危人群具有化学预防作用。
