他汀类药物、阿司匹林与子宫内膜癌女性静脉血栓栓塞症的相关性。
Association of statins, aspirin, and venous thromboembolism in women with endometrial cancer.
机构信息
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA.
出版信息
Gynecol Oncol. 2019 Mar;152(3):605-611. doi: 10.1016/j.ygyno.2018.12.020. Epub 2019 Jan 5.
OBJECTIVE
The anti-thrombogenic effects of statins and aspirin have been reported in various malignancies but have not been well examined in endometrial cancer. This study examined the association between statin and/or aspirin use and venous thromboembolism (VTE) risk in endometrial cancer.
METHODS
This is a multi-center retrospective study examining 2527 women with endometrial cancer between 2000 and 2015. Statin and aspirin use at diagnosis was correlated to VTE risk during follow-up on multivariable analysis.
RESULTS
There were 132 VTE events with a 5-year cumulative incidence rate of 6.1%. There were 392 (15.5%) statin users and 219 (8.7%) aspirin users, respectively. On multivariable analysis, statin use was associated with an approximately 60% decreased risk of VTE when compared to non-users (5-year cumulative rates 2.5% versus 6.7%, adjusted-hazard ratio [HR] 0.42, 95% confidence interval [CI] 0.19-0.92, P = 0.030) whereas aspirin did not demonstrate statistical significance (2.0% versus 6.5%, adjusted-HR 0.54, 95%CI 0.19-1.51, P = 0.24). There was a trend of joint effect between statin and aspirin although it did not demonstrate statistical significance: VTE risks for dual statin/aspirin user (adjusted-HR 0.27, 95%CI 0.04-2.07), statin alone (adjusted-HR 0.40, 95%CI 0.18-0.93), and aspirin alone (adjusted-HR 0.51, 95%CI 0.16-1.64) compared to non-use after adjusting for patient characteristics, tumor factors, treatment types, and survival events (P-interaction = 0.090). When stratified by statin type, simvastatin demonstrated the largest reduction of VTE risk (5-year cumulative rates 1.1% versus 6.7%, adjusted-HR 0.17, 95%CI 0.02-1.30, P = 0.088). Obesity, absence of diabetes mellitus, type II histology, and recurrent disease were the factors associated with decreased VTE risk with statin use (all, P-interaction<0.05).
CONCLUSION
Our study suggests that statin use may be associated with decreased risk of VTE in women with endometrial cancer.
目的
他汀类药物和阿司匹林的抗血栓作用已在各种恶性肿瘤中得到报道，但尚未在子宫内膜癌中得到充分研究。本研究旨在探讨他汀类药物和/或阿司匹林的使用与子宫内膜癌患者静脉血栓栓塞（VTE）风险之间的相关性。
方法
这是一项多中心回顾性研究，共纳入了 2000 年至 2015 年间 2527 例子宫内膜癌患者。在多变量分析中，将诊断时使用他汀类药物和/或阿司匹林与随访期间的 VTE 风险相关联。
结果
共有 132 例 VTE 事件，5 年累积发生率为 6.1%。分别有 392 例（15.5%）患者使用了他汀类药物，219 例（8.7%）患者使用了阿司匹林。多变量分析显示，与未使用者相比，使用他汀类药物可使 VTE 风险降低约 60%（5 年累积发生率分别为 2.5%和 6.7%，调整后危险比 [HR]0.42，95%置信区间 [CI]0.19-0.92，P=0.030），而阿司匹林则无统计学意义（2.0%和 6.5%，调整后 HR 0.54，95%CI 0.19-1.51，P=0.24）。尽管联合使用他汀类药物和阿司匹林的效果呈趋势，但未达到统计学意义：与未使用者相比，双重使用他汀类药物/阿司匹林的患者（调整后 HR 0.27，95%CI 0.04-2.07）、单独使用他汀类药物的患者（调整后 HR 0.40，95%CI 0.18-0.93）和单独使用阿司匹林的患者（调整后 HR 0.51，95%CI 0.16-1.64），在调整了患者特征、肿瘤因素、治疗类型和生存事件后，VTE 风险降低（P 交互作用=0.090）。按他汀类药物类型分层时，辛伐他汀降低 VTE 风险的效果最大（5 年累积发生率分别为 1.1%和 6.7%，调整后 HR 0.17，95%CI 0.02-1.30，P=0.088）。肥胖、无糖尿病、II 型组织学和疾病复发是与他汀类药物使用相关的降低 VTE 风险的因素（所有因素，P 交互作用<0.05）。
结论
本研究表明，在子宫内膜癌患者中，他汀类药物的使用可能与降低 VTE 风险相关。
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