Department of Gynecology, The First Affiliated Hospital of China Medical University, Shenyang, China.
Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China.
Br J Clin Pharmacol. 2018 Jun;84(6):1109-1120. doi: 10.1111/bcp.13559. Epub 2018 Apr 2.
To comprehensively evaluate the association between postdiagnostic statin use and mortality of ovarian cancer (OC) patients.
Using a comprehensive strategy, multiple databases (Medline, Embase and Web of Science) were systematically searched to identify observational studies that examined the correlation between statin use and OC mortality up to 31 December 2017. The studies were independently reviewed and selected based on predetermined selection criteria. Data were extracted independently and in duplicate. The risk of bias was evaluated with the Newcastle-Ottawa scale. Hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality were summarized with a profile likelihood random effects model.
Of 269 studies, eight cohort studies of 19 904 OC patients met the inclusion criteria. Postdiagnostic statin use was inversely associated with all-cause mortality/overall survival (summarized HR = 0.74; 95%CI = 0.63-0.87; I = 55%; n = 7) and cancer-specific mortality (summarized HR = 0.87; 95%CI = 0.80-0.95; I = 0%; n = 3) of OC patients. These findings were consistent by subgroup analyses stratified by study and patient characteristics as well as adjustments made for potential confounders. A meta-regression analysis found no effect of modification by these variables. Of note, similar significant inverse effects were also observed when increasing the intensity (highest vs. lowest) of postdiagnostic statin use (summarized HR = 0.84; 95%CI = 0.74-0.96; I = 0%; n = 3).
Postdiagnostic statin use can improve the survival of patients with OC. Further prospective cohort and randomized controlled trials are warranted to confirm the therapeutic role of statin use on the outcome of OC.
全面评估卵巢癌（OC）患者诊断后使用他汀类药物与死亡率之间的关联。
采用综合策略，系统检索多个数据库（Medline、Embase 和 Web of Science），以确定截至 2017 年 12 月 31 日检查他汀类药物使用与 OC 死亡率之间相关性的观察性研究。根据预先确定的选择标准独立审查和选择研究。独立且重复提取数据。使用 Newcastle-Ottawa 量表评估偏倚风险。使用似然随机效应模型汇总死亡率的风险比（HR）和 95%置信区间（CI）。
在 269 项研究中，有 8 项队列研究纳入了 19904 名 OC 患者，符合纳入标准。诊断后使用他汀类药物与全因死亡率/总生存率呈负相关（汇总 HR=0.74；95%CI=0.63-0.87；I²=55%；n=7）和 OC 患者的癌症特异性死亡率（汇总 HR=0.87；95%CI=0.80-0.95；I²=0%；n=3）。这些发现通过按研究和患者特征分层的亚组分析以及对潜在混杂因素的调整是一致的。Meta 回归分析发现这些变量的修饰没有影响。值得注意的是，当增加诊断后他汀类药物使用的强度（最高与最低）时，也观察到类似的显著负向效果（汇总 HR=0.84；95%CI=0.74-0.96；I²=0%；n=3）。
诊断后使用他汀类药物可以改善 OC 患者的生存。需要进一步进行前瞻性队列研究和随机对照试验，以确认他汀类药物使用对 OC 结局的治疗作用。
