Shi Meng, Zheng Huiling, Nie Biao, Gong Wei, Cui Xiaobing
Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
BMJ Open. 2014 Sep 16;4(9):e005399. doi: 10.1136/bmjopen-2014-005399.
Statins are commonly prescribed cholesterol-lowering drugs. Preclinical studies suggest that statins may possess cancer preventive properties. The primary objective of this meta-analysis was to determine the association between statin use and risk of liver cancer.
Meta-analysis.
International.
A comprehensive literature search of PubMed, BIOSIS Previews, Web of Science, EMBASE, EBSCO and Cochrane Library was conducted through March 2014. The effect estimate was reported as pooled relative risk (RR) with 95% CIs, using the random-effects model.
A total of 12 studies (1 individual patient data analysis of 22 randomised controlled trials, 5 cohorts and 6 case-controls) were qualified for this meta-analysis, involving 5,640,313 participants including 35,756 liver cancer cases. Our results indicated a significant risk reduction of liver cancer among all statin users (RR=0.58, 95% CIs 0.51 to 0.67). The difference of the study designs can partly explain the significant heterogeneity found in the overall analysis (I(2)=65%, p=0.0006). No evidence of publication bias was observed in this meta-analysis. Similar risk reductions were found in the subgroups analysis of Western and Asian countries, lipophilic and hydrophilia statins. There was a trend towards more risk reductions in subgroups with higher baseline risk, inadequate adjustment and higher cumulative dosage of statin use.
This meta-analysis suggests that statin is associated with a significant risk reduction of liver cancer when taken daily for cardiovascular event prevention. However, this preventive effect might be overestimated due to the exposure period, the indication and contraindication of statins and other confounders. Statins might be considered as an adjuvant in the treatment of liver cancer.
他汀类药物是常用的降胆固醇药物。临床前研究表明，他汀类药物可能具有防癌特性。本荟萃分析的主要目的是确定他汀类药物的使用与肝癌风险之间的关联。
荟萃分析。
国际。
截至2014年3月，对PubMed、BIOSIS Previews、科学网、EMBASE、EBSCO和考克兰图书馆进行了全面的文献检索。采用随机效应模型，效应估计值报告为合并相对风险（RR）及95%可信区间（CI）。
共有12项研究（1项对22项随机对照试验、5项队列研究和6项病例对照研究的个体患者数据分析）符合本荟萃分析的要求，涉及5640313名参与者，其中包括35756例肝癌病例。我们的结果表明，所有他汀类药物使用者的肝癌风险显著降低（RR = 0.58，95% CI为0.51至0.67）。研究设计的差异可以部分解释在总体分析中发现的显著异质性（I² = 65%，p = 0.0006）。本荟萃分析未观察到发表偏倚的证据。在西方国家和亚洲国家、亲脂性他汀类药物和亲水性他汀类药物的亚组分析中也发现了类似的风险降低情况。在基线风险较高、调整不足和他汀类药物累积剂量较高的亚组中，有更多风险降低的趋势。
本荟萃分析表明，每天服用他汀类药物预防心血管事件时，与肝癌风险显著降低相关。然而，由于他汀类药物的暴露期、适应证和禁忌证以及其他混杂因素，这种预防效果可能被高估。他汀类药物可被视为肝癌治疗的辅助药物。
