Center of Clinical Laboratory Science, Jiangsu Cancer Hospital Affiliated to Nanjing Medical University, Nanjing 210009, China.
Departments of Oncology, Xuzhou Medical College, Xuzhou 221004, China.
Cancer Treat Rev. 2015 Jun;41(6):554-67. doi: 10.1016/j.ctrv.2015.04.005. Epub 2015 Apr 11.
Previous studies have examined the effect of statin use on the mortality in cancer patients, but the results are inconsistent. A meta-analysis was performed to assess the association with all available studies.
Relevant studies were identified by searching PubMed and EMBASE to April 2015. We calculated the summary hazard ratios (HRs) and 95% confidence intervals (CIs) using random-effects models. We estimated combined HRs associated with defined increments of statin use, using random-effects meta-analysis and dose-response meta-regression models.
Thirty-nine cohort studies and two case-control studies involving 990,649 participants were included. The results showed that patients who used statins after diagnosis had a HR of 0.81 (95% CI: 0.72-0.91) for all-cause mortality compared to non-users. Those who used statin after diagnosis (vs. non-users) had a HR of 0.77 (95% CI: 0.66-0.88) for cancer-specific mortality. Prediagnostic exposure to statin was associated with both all-cause mortality (HR=0.79, 95% CI: 0.74-0.85) and cancer-specific mortality (HR=0.69, 95% CI: 0.60-0.79). Stratifying by cancer type, the three largest cancer-type subgroups were colorectal, prostate and breast cancer and all showed a benefit from statin use. HRs per 365 defined daily doses increment were 0.80 (95% CI: 0.69-0.92) for all-cause mortality and 0.77 (95% CI: 0.67-0.89) for cancer-specific mortality. A 1year increment in duration only conferred a borderline decreased risk of death.
In conclusion, the average effect of statin use, both postdiagnosis and prediagnosis, is beneficial for overall survival and cancer-specific survival.
先前的研究已经考察了他汀类药物使用对癌症患者死亡率的影响，但结果并不一致。进行了一项荟萃分析，以评估所有可用研究的相关性。
通过搜索 PubMed 和 EMBASE 至 2015 年 4 月，确定了相关研究。我们使用随机效应模型计算了汇总危害比（HRs）和 95%置信区间（CIs）。我们使用随机效应荟萃分析和剂量-反应荟萃回归模型，估算了与他汀类药物使用的特定增量相关的联合 HRs。
纳入了 39 项队列研究和 2 项病例对照研究，共涉及 990649 名参与者。结果表明，与未使用者相比，诊断后使用他汀类药物的患者全因死亡率的 HR 为 0.81（95%CI：0.72-0.91）。与未使用者相比，诊断后（vs.未使用者）使用他汀类药物的患者癌症特异性死亡率的 HR 为 0.77（95%CI：0.66-0.88）。他汀类药物的预测暴露与全因死亡率（HR=0.79，95%CI：0.74-0.85）和癌症特异性死亡率（HR=0.69，95%CI：0.60-0.79）均相关。按癌症类型分层，三个最大的癌症类型亚组为结直肠癌、前列腺癌和乳腺癌，所有亚组均显示出他汀类药物使用的获益。每增加 365 天定义的每日剂量，全因死亡率的 HR 为 0.80（95%CI：0.69-0.92），癌症特异性死亡率的 HR 为 0.77（95%CI：0.67-0.89）。仅增加 1 年的持续时间与死亡风险略有降低相关。
总之，他汀类药物的使用，无论是诊断后还是诊断前，平均效果都有利于总体生存和癌症特异性生存。
