Department of Gastroenterology, Zhejiang University Medical School, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
Cancer Med. 2019 Jun;8(6):3305-3313. doi: 10.1002/cam4.2151. Epub 2019 May 8.
Colorectal cancer (CRC) remains one of the most common types of cancer and a leading cause of death worldwide. Previous studies indicated that statins may have a potential protective effect on CRC.
We conducted this meta-analysis to systematically assess the overall and cancer-specific survival benefit of statin uses on CRC patients. Related references were identified through PubMed, the Cochrane Library, Web of Science, EMBASE, and SCOPUS from inception to August 2017. Adjusted hazard ratios (HRs) were adopted to calculate summary hazard ratios (HRs) with 95% confidence intervals (95% CIs), using a random-effects model.
Total fourteen studies involving 130 994 patients were included in this meta-analysis. Six studies reported the association between pre-diagnosis statin uses and CRC mortality, while 11 studies investigated mortality in patients using statins after CRC diagnosis. For pre-diagnosis statin uses, the pooled HR of all-cause mortality (ACM) was 0.85 (95% CI, 0.79-0.92) and the pooled HR of cancer-specific mortality (CSM) was 0.82 (95% CI, 0.79-0.86). In terms of post-diagnosis statin uses, the pooled HR of ACM was 0.86 (95% CI, 0.76-0.98), and the pooled HR of CSM was 0.79 (95% CI, 0.70-0.89). For post-diagnosis statin uses, there is no difference in ACM when stratified by KRAS gene (KRAS) mutation status. Results of ACM and CSM did not markedly alter in other subgroup analyses.
Our meta-analysis demonstrates that both pre-diagnosis and post-diagnosis statin uses are associated with reduced ACM and CSM for CRC patients.
结直肠癌（CRC）仍然是最常见的癌症类型之一，也是全球范围内主要的死亡原因。先前的研究表明，他汀类药物可能对 CRC 具有潜在的保护作用。
我们进行了这项荟萃分析，以系统评估他汀类药物使用对 CRC 患者的总体和癌症特异性生存获益。相关参考文献通过 PubMed、Cochrane 图书馆、Web of Science、EMBASE 和 SCOPUS 从创建到 2017 年 8 月进行了检索。采用随机效应模型，采用调整后的危险比（HR）计算汇总危险比（HR）及其 95%置信区间（95%CI）。
共有 14 项研究，涉及 130994 例患者，纳入本荟萃分析。6 项研究报告了诊断前使用他汀类药物与 CRC 死亡率之间的关系，而 11 项研究则调查了 CRC 诊断后使用他汀类药物患者的死亡率。对于诊断前使用他汀类药物，全因死亡率（ACM）的汇总 HR 为 0.85（95%CI，0.79-0.92），癌症特异性死亡率（CSM）的汇总 HR 为 0.82（95%CI，0.79-0.86）。关于诊断后使用他汀类药物，ACM 的汇总 HR 为 0.86（95%CI，0.76-0.98），CSM 的汇总 HR 为 0.79（95%CI，0.70-0.89）。对于诊断后使用他汀类药物，KRAS 基因突变状态分层时，ACM 无差异。其他亚组分析的 ACM 和 CSM 结果没有明显改变。
本荟萃分析表明，诊断前和诊断后使用他汀类药物均可降低 CRC 患者的 ACM 和 CSM。
