E Jian-Yu, Lu Shou-En, Lin Yong, Graber Judith M, Rotter David, Zhang Lanjing, Petersen Gloria M, Demissie Kitaw, Lu-Yao Grace, Tan Xiang-Lin
Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, New Jersey.
Department of Epidemiology, School of Public Health, Rutgers, The State University of New Jersey, Piscataway, New Jersey.
Cancer Epidemiol Biomarkers Prev. 2017 Aug;26(8):1225-1232. doi: 10.1158/1055-9965.EPI-17-0227. Epub 2017 Jun 15.
Published evidence indicates that individual use of metformin and statin is associated with reduced cancer mortality. However, their differential and joint effects on pancreatic cancer survival are inconclusive. We identified a large population-based cohort of 12,572 patients ages 65 years or older with primary pancreatic ductal adenocarcinoma (PDAC) diagnosed between 2008 and 2011 from the Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database. Exposure to metformin and statins was ascertained from Medicare Prescription Drug Event files. Cox proportional hazards models with time-varying covariates adjusted for propensity scores were used to assess the association while controlling for potential confounders. Of 12,572 PDAC patients, 950 (7.56%) had used metformin alone, 4,506 (35.84%) had used statin alone, and 2,445 (19.45%) were dual users. Statin use was significantly associated with improved overall survival [HR, 0.94; 95% confidence interval (CI), 0.90-0.98], and survival was more pronounced in postdiagnosis statin users (HR, 0.69; 95% CI, 0.56-0.86). Metformin use was not significantly associated with overall survival (HR, 1.01; 95% CI, 0.94-1.09). No beneficial effect was observed for dual users (HR, 1.00; 95% CI, 0.95-1.05). Our findings suggest potential benefits of statins on improving survival among elderly PDAC patients; further prospective studies are warranted to corroborate the putative benefit of statin therapy in pancreatic cancer. Although more studies are needed to confirm our findings, our data add to the body of evidence on potential anticancer effects of statins. .
已发表的证据表明，单独使用二甲双胍和他汀类药物与降低癌症死亡率相关。然而，它们对胰腺癌生存率的差异和联合影响尚无定论。我们从监测、流行病学和最终结果（SEER）-医疗保险关联数据库中确定了一个基于人群的大型队列，其中包括12572名年龄在65岁及以上、2008年至2011年间被诊断为原发性胰腺导管腺癌（PDAC）的患者。通过医疗保险处方药事件文件确定二甲双胍和他汀类药物的使用情况。使用具有随时间变化协变量并根据倾向得分进行调整的Cox比例风险模型来评估关联，同时控制潜在混杂因素。在12572名PDAC患者中，950名（7.56%）仅使用过二甲双胍，4506名（35.84%）仅使用过他汀类药物，2445名（19.45%）为双重使用者。使用他汀类药物与总体生存率改善显著相关[风险比（HR），0.94；95%置信区间（CI），0.90-0.98]，且诊断后使用他汀类药物的患者生存率改善更明显（HR，0.69；95%CI，0.56-0.86）。使用二甲双胍与总体生存率无显著关联（HR，1.01；95%CI，0.94-1.09）。双重使用者未观察到有益效果（HR，1.00；95%CI，0.95-1.05）。我们的研究结果表明他汀类药物对提高老年PDAC患者生存率具有潜在益处；有必要进行进一步的前瞻性研究以证实他汀类药物治疗在胰腺癌中的假定益处。尽管需要更多研究来证实我们的发现，但我们的数据增加了关于他汀类药物潜在抗癌作用的证据。
