Am J Epidemiol. 2017 Sep 15;186(6):679-687. doi: 10.1093/aje/kww245.
In earlier studies of the influence of hydroxymethylglutaryl-coenzyme A reductase inhibitors (also known as statins) on colorectal cancer prognosis, investigators reported a reduced rate of cancer-specific mortality. Studies of recurrence are few and small. Using data from Danish registries, we followed 21,152 patients diagnosed with stage I-III colorectal cancer from 2001 to 2011. We estimated the association between statin use in the preceding year and cancer recurrence, cancer-specific mortality, and all-cause mortality rates. We identified 5,036 recurrences, 7,084 deaths from any cause, and 4,066 deaths from colorectal cancer. After adjustment for potential confounders, statin use was not associated with recurrence (adjusted hazard ratio (aHR) = 1.01, 95% confidence interval (CI): 0.93, 1.09), but it was associated with death from colorectal cancer (aHR = 0.72, 95% CI: 0.65, 0.79) and death from any cause (aHR = 0.72, 95% CI: 0.67, 0.76). Statin use in the year preceding recurrence was associated with a reduced risk of cancer-specific mortality (aHR = 0.83, 95% CI: 0.74, 0.92) but also a reduced risk of death from any other cause (aHR = 0.78, 95% CI: 0.61, 1.00). Statin use was not associated with a reduced rate of colorectal cancer recurrence, but it was associated with a reduced rate of cancer-specific mortality, which suggests that there is no cancer-directed benefit; therefore, there is no basis to prescribe statins to colorectal cancer patients who do not have cardiovascular indications.
在之前关于羟甲基戊二酰辅酶 A 还原酶抑制剂(也称为他汀类药物)对结直肠癌预后影响的研究中,研究人员报告了癌症特异性死亡率降低。关于复发的研究很少且规模较小。我们使用来自丹麦登记处的数据,对 2001 年至 2011 年间诊断为 I-III 期结直肠癌的 21152 名患者进行了随访。我们估计了前一年使用他汀类药物与癌症复发、癌症特异性死亡率和全因死亡率之间的关联。我们确定了 5036 例复发、7084 例任何原因导致的死亡和 4066 例结直肠癌导致的死亡。在调整了潜在混杂因素后,他汀类药物的使用与复发无关(调整后的危险比[aHR] = 1.01,95%置信区间[CI]:0.93,1.09),但与结直肠癌导致的死亡(aHR = 0.72,95% CI:0.65,0.79)和任何原因导致的死亡(aHR = 0.72,95% CI:0.67,0.76)相关。复发前一年使用他汀类药物与癌症特异性死亡率降低相关(aHR = 0.83,95% CI:0.74,0.92),但也与任何其他原因导致的死亡风险降低相关(aHR = 0.78,95% CI:0.61,1.00)。他汀类药物的使用与结直肠癌复发率的降低无关,但与癌症特异性死亡率的降低有关,这表明没有针对癌症的获益;因此,没有依据向没有心血管指征的结直肠癌患者开具他汀类药物。