Facciorusso Antonio, Abd El Aziz Mohamed A, Singh Siddharth, Pusceddu Sara, Milione Massimo, Giacomelli Luca, Sacco Rodolfo
Section of Gastroenterology, Department of Medical Sciences, University of Foggia, 71122 Foggia, Italy.
Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Cancers (Basel). 2020 Apr 3;12(4):874. doi: 10.3390/cancers12040874.
Statins can decrease hepatocellular carcinoma (HCC) occurrence, but the magnitude and the predictors of these effects remain unclear. This meta-analysis provides a pooled estimate of the impact of statin use on HCC occurrence. Pooled effects were calculated using a random-effects model by means of the DerSimonian and Laird test. Primary endpoint was the time-dependent correlation between statin use and HCC incidence expressed as hazard ratio (HR), both crude and adjusted. The crude and adjusted odds ratios (OR) for HCC occurrence between statin users and non-users were analyzed. Twenty-five studies with 1,925,964 patients were included. Crude OR for HCC incidence was 0.59 (95% CI: 0.47-0.74), confirmed in adjusted analysis (OR: 0.74, 95% CI: 0.70-0.78). Adjusted HR was 0.73 (95% CI: 0.69-0.76). This effect was more pronounced in HBV patients (HR: 0.46, 95% CI: 0.36-0.60) and with a cumulative daily dose beyond 365 (HR: 0.27, 95% CI: 0.11-0.67). Lipophilic statins were associated with reduced HCC incidence (HR: 0.49, 95% CI: 0.39-0.62). Atorvastatin determined the greater magnitude of effect (HR: 0.43, 95% CI: 0.28-0.65). This meta-analysis demonstrates the beneficial chemopreventive effect of statins against HCC occurrence. This effect is dose-dependent and more pronounced with lipophilic statins.
他汀类药物可降低肝细胞癌（HCC）的发生率，但其效果的程度及预测因素仍不明确。本荟萃分析对使用他汀类药物对HCC发生的影响进行了汇总估计。采用DerSimonian和Laird检验的随机效应模型计算汇总效应。主要终点是他汀类药物使用与HCC发病率之间的时间依赖性相关性，以风险比（HR）表示，包括粗风险比和调整后风险比。分析了他汀类药物使用者与非使用者之间HCC发生的粗比值比（OR）和调整后比值比。纳入了25项研究，共1925964例患者。HCC发病率的粗OR为0.59（95%CI：0.47 - 0.74），在调整分析中得到证实（OR：0.74，95%CI：0.70 - 0.78）。调整后的HR为0.73（95%CI：0.69 - 0.76）。这种效应在乙肝患者中更为明显（HR：0.46，95%CI：0.36 - 0.60），且每日累积剂量超过365时（HR：0.27，95%CI：0.11 - 0.67）。亲脂性他汀类药物与HCC发病率降低相关（HR：0.49，95%CI：0.39 - 0.62）。阿托伐他汀的效果最为显著（HR：0.43，95%CI：0.28 - 0.65）。本荟萃分析表明他汀类药物对HCC发生具有有益的化学预防作用。这种作用具有剂量依赖性，且亲脂性他汀类药物更为明显。
