Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong.
Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, Hong Kong.
Gut. 2019 Nov;68(11):1979-1985. doi: 10.1136/gutjnl-2018-317714. Epub 2019 Feb 26.
Postcolonoscopy colorectal cancer (PCCRC) accounts for up to 9% of all CRCs. Statins have been shown to be associated with a lower CRC risk. We aimed to investigate whether PCCRC risk was also lower among statin users.
This is a retrospective cohort study using a territory-wide electronic healthcare database in Hong Kong including patients aged 40 years or above who had undergone colonoscopies between 2005 and 2013. Exclusion criteria included prior colorectal cancer (CRC), inflammatory bowel disease, prior colectomy and CRC detected within 6 months of index colonoscopy. We defined statin use as at least 90-day use before index colonoscopy. Medication use was traced up to 5 years before index colonoscopy. PCCRC-3y was defined as cancer diagnosed between 6 and 36 months after index colonoscopy. Sites of CRC were categorised as proximal (proximal to splenic flexure) and distal cancer. The subdistribution HR (SHR) of PCCRC-3y with statin use was derived by propensity score matching based on covariates (including patient factors, concurrent medication use and endoscopy centre's performance).
Of 187 897 eligible subjects, 854 (0.45%) were diagnosed with PCCRC-3y. Statin use was associated with a lower PCCRC-3y risk (SHR: 0.72; 95% CI 0.55 to 0.95; p=0.018). Subgroup analysis shows that SHRs were 0.50 (95% CI 0.28 to 0.91; p=0.022) for proximal and 0.80 (95% CI 0.59 to 1.09; p=0.160) for distal cancer. Older (>60 years) patients, women and those without diabetes mellitus or polyps appeared to benefit more from statins.
Statins were associated with a lower PCCRC risk, particularly for proximal cancer.
结肠镜检查后的结直肠癌（PCCRC）占所有 CRC 的比例高达 9%。他汀类药物已被证明与 CRC 风险降低有关。我们旨在研究他汀类药物使用者的 PCCRC 风险是否也较低。
这是一项使用香港全港电子医疗数据库的回顾性队列研究，纳入 2005 年至 2013 年间接受结肠镜检查的年龄在 40 岁或以上的患者。排除标准包括先前的结直肠癌（CRC）、炎症性肠病、先前的结肠切除术和 CRC 在索引结肠镜检查后 6 个月内检出。我们将他汀类药物的使用定义为在索引结肠镜检查前至少使用 90 天。药物使用情况追溯到索引结肠镜检查前 5 年。PCCRC-3y 定义为在索引结肠镜检查后 6 至 36 个月内诊断出的癌症。CRC 部位分为近端（脾曲之前）和远端癌症。通过倾向评分匹配基于协变量（包括患者因素、同时使用的药物和内窥镜中心的表现）得出 PCCRC-3y 的亚分布 HR（SHR）。
在 187897 名合格的受试者中，有 854 名（0.45%）被诊断为 PCCRC-3y。他汀类药物的使用与 PCCRC-3y 的风险降低相关（SHR：0.72；95%CI 0.55 至 0.95；p=0.018）。亚组分析显示，近端 SHR 为 0.50（95%CI 0.28 至 0.91；p=0.022），远端 SHR 为 0.80（95%CI 0.59 至 1.09；p=0.160）。年龄较大（>60 岁）的患者、女性以及没有糖尿病或息肉的患者似乎从他汀类药物中获益更多。
他汀类药物与 PCCRC 风险降低相关，特别是对近端癌症。
