Shaitelman Simona F, Stauder Michael C, Allen Pamela, Reddy Sangeetha, Lakoski Susan, Atkinson Bradley, Reddy Jay, Amaya Diana, Guerra William, Ueno Naoto, Caudle Abigail, Tereffe Welela, Woodward Wendy A
Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX.
Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX.
J Cancer. 2017 Jul 5;8(11):2026-2032. doi: 10.7150/jca.18743. eCollection 2017.
We sought to investigate if the use of HMG Co-A reductase inhibitors (statins) has an impact on outcomes among patients with triple negative breast cancer (TNBC). We reviewed the cases of women with invasive, non-metastatic TNBC, diagnosed 1997-2012. Clinical outcomes were compared based on statin use (defined as ever use during treatment vs. never use). We identified a subset of women for whom a 5-value lipid panel (5VLP) was available, including total cholesterol, low density lipoprotein, high density lipoprotein, very low density lipoprotein, and triglycerides. The Kaplan-Meier method was used to estimate median overall survival (OS), distant metastases-free survival (DMFS), and local-regional recurrence-free survival (LRRFS). A Cox proportional hazards regression model was used to test the statistical significance of prognostic factors. 869 women were identified who met inclusion criteria, with a median follow-up time of 75.1 months (range 2.4-228.9 months). 293 (33.7%) patients used statins and 368 (42.3%) had a 5VLP. OS, DMFS, and LRRFS were not significant based on statin use or type. Controlling for the 5VLP values, on multivariable analysis, statin use was significantly associated with OS (HR 0.10, 95% CI 0.01-0.76), but not with DMFS (HR 0.14, 95% CI 0.01-1.40) nor LRRFS (HR 0.10 95% CI 0.00-3.51). Statin use among patients with TNBC is not associated with improved OS, although it may have a benefit for a subset of patients. Prospective assessment would be valuable to better assess the potential complex correlation between clinical outcome, lipid levels, and statin use.
我们试图研究使用HMG Co-A还原酶抑制剂（他汀类药物）是否会对三阴性乳腺癌（TNBC）患者的预后产生影响。我们回顾了1997年至2012年期间诊断为浸润性、非转移性TNBC的女性病例。根据他汀类药物的使用情况（定义为治疗期间曾使用与从未使用）比较临床预后。我们确定了一部分有5项血脂指标（5VLP）数据的女性，包括总胆固醇、低密度脂蛋白、高密度脂蛋白、极低密度脂蛋白和甘油三酯。采用Kaplan-Meier方法估计中位总生存期（OS）、无远处转移生存期（DMFS）和无局部区域复发生存期（LRRFS）。使用Cox比例风险回归模型检验预后因素的统计学意义。共确定了869名符合纳入标准的女性，中位随访时间为75.1个月（范围2.4 - 228.9个月）。293名（33.7%）患者使用了他汀类药物，368名（42.3%）有5VLP数据。基于他汀类药物的使用情况或类型，OS、DMFS和LRRFS无显著差异。在多变量分析中，控制5VLP值后，他汀类药物的使用与OS显著相关（风险比[HR] 0.10，95%置信区间[CI] 0.01 - 0.76），但与DMFS（HR 0.14，95% CI 0.01 - 1.40）和LRRFS（HR 0.10，95% CI 0.00 - 3.51）无关。TNBC患者使用他汀类药物与OS改善无关，尽管可能对一部分患者有益。前瞻性评估对于更好地评估临床结局、血脂水平和他汀类药物使用之间潜在的复杂相关性将是有价值的。
