Second Department of Respiratory and Critical Care Medicine, Xinxiang Central Hospital, Xinxiang, Henan, China.
Department of General Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China.
Pharmacol Res. 2019 Mar;141:357-365. doi: 10.1016/j.phrs.2019.01.016. Epub 2019 Jan 11.
Statin exposure has been reported to improve survival in several cancers. However, studies evaluating the association between statins and prognostic outcomes in patients with lung cancer are conflicting and heterogeneous. Pubmed, EMBASE and reference lists of included studies were searched to identify studies investigating the association between statin exposure and lung cancer prognosis. The primary outcome measure was overall survival (OS) and secondary ones included cancer-specific survival (CSS) and recurrence-free survival (RFS). Hazard ratios (HRs) with 95% confidence intervals (95% CIs) of these outcomes were pooled using random-effects models. Thirteen studies with data from 99,297 individuals satisfying the inclusion criteria were identified. Studies were ranked to be at low to moderate risk of bias. Meta-analysis showed that statin exposure was significantly associated with improved OS (pooled HR 0.79, 95% CI 0.72-0.86), CSS (pooled HR 0.83, 95% CI 0.77-0.89) and RFS (pooled HR 0.85, 95% CI 0.81-0.89). Subgroup analyses showed that statin users after diagnosis of lung cancer had more survival benefit for OS (HR 0.68, 95% CI 0.51-0.92) than those before diagnosis (HR 0.86, 95% CI 0.81-0.90) and current users (HR 0.79, 95% CI 0.62-1.02) (P for interaction <0.001). Besides, statin users were likely to have more survival benefits in stage IV lung cancer patients (HR 0.77, 95% CI 0.74-0.79) than in mixed stage (I-IV or I-III) patients (P for interaction = 0.004). Statin exposure is associated with significantly improved survival in patients with lung cancer. Future studies are warranted to further demonstrate the therapeutic role of statins in specific lung cancer patients.
他汀类药物的暴露已被报道可改善几种癌症的存活率。然而，评估他汀类药物与肺癌患者预后之间关联的研究结果存在冲突和异质性。检索了 Pubmed、EMBASE 和纳入研究的参考文献列表，以确定研究他汀类药物暴露与肺癌预后之间关联的研究。主要结局测量是总生存率（OS），次要结局包括癌症特异性生存率（CSS）和无复发生存率（RFS）。使用随机效应模型汇总这些结局的风险比（HR）及其 95%置信区间（95%CI）。确定了 13 项符合纳入标准的研究，这些研究的数据来自 99297 名个体。研究被评为低至中度偏倚风险。荟萃分析显示，他汀类药物暴露与 OS（汇总 HR 0.79，95%CI 0.72-0.86）、CSS（汇总 HR 0.83，95%CI 0.77-0.89）和 RFS（汇总 HR 0.85，95%CI 0.81-0.89）显著相关。亚组分析显示，肺癌诊断后使用他汀类药物的患者 OS（HR 0.68，95%CI 0.51-0.92）的生存获益大于诊断前（HR 0.86，95%CI 0.81-0.90）和当前使用者（HR 0.79，95%CI 0.62-1.02）（P 交互<0.001）。此外，与混合期（I-IV 或 I-III）患者相比，IV 期肺癌患者使用他汀类药物更可能具有生存获益（HR 0.77，95%CI 0.74-0.79）（P 交互=0.004）。他汀类药物暴露与肺癌患者的生存率显著提高相关。需要进一步的研究来进一步证明他汀类药物在特定肺癌患者中的治疗作用。
