Division of Hematology-Oncology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-yi, Taiwan.
Min-Hwei Junior College of Health Care Management, Tainan, Taiwan.
Breast Cancer Res Treat. 2021 Feb;185(3):773-783. doi: 10.1007/s10549-020-05969-9. Epub 2020 Oct 16.
Many studies have revealed that statin therapy reduced mortality in cancer patients, especially in breast cancer, but the effect for second cancer was unclear. We, therefore, performed a comparable cohort study to determine the risk of second cancer in breast cancer patients with statin therapy.
Using claims data from Taiwan's National Health Insurance Program, this study enrolled newly diagnosed breast cancer patients from 2000 to 2007 with and without statin therapy as the statin (n = 1222) and nonstatin (n = 4888) cohorts, respectively. The nonstatin cohort was propensity score matched by cohort entry year, age, and randomly selected comorbidities. These two cohorts were followed up until the diagnosis of second cancer, death, or the end of 2011. Cox proportional hazard models were used to estimate the hazard ratios.
The statin cohort had a lower incidence rate than the nonstatin cohort for second cancer (7.37 vs. 8.36 per 1000 person-years), although the difference was not significant (adjusted hazard ratio [aHR] 0.90, 95% confidence interval [CI] 0.65-1.26). Compared with the nonstatin cohort, the second cancer risk was significantly higher for patients taking pravastatin (aHR 2.71, 95% CI 1.19-6.19) but lower for those receiving multiple statin treatment (aHR 0.45, 95% CI 0.25-0.81) and combined lipophilic and hydrophilic type of statin (aHR 0.42, 95% CI 0.20-0.89). The risk was lower for patients receiving a cumulative defined daily dose (cDDD) of > 430 (aHR 0.41, 95% CI 0.19-0.86).
This study showed that there is little association between statin use and second cancer risk in breast cancer patients.
许多研究表明，他汀类药物治疗可降低癌症患者的死亡率，尤其是乳腺癌患者，但对第二癌症的影响尚不清楚。因此，我们进行了一项可比队列研究，以确定接受他汀类药物治疗的乳腺癌患者发生第二癌症的风险。
本研究使用来自台湾全民健康保险计划的理赔数据，纳入了 2000 年至 2007 年间新诊断的乳腺癌患者，根据是否接受他汀类药物治疗分为他汀类药物组（n=1222）和非他汀类药物组（n=4888）。非他汀类药物组按照入组年份、年龄和随机选择的合并症进行倾向评分匹配。这两个队列均随访至第二癌症诊断、死亡或 2011 年底。采用 Cox 比例风险模型估计风险比。
他汀类药物组的第二癌症发生率低于非他汀类药物组（每 1000 人年 7.37 例 vs. 8.36 例），但差异无统计学意义（调整后的风险比[aHR]0.90，95%置信区间[CI]0.65-1.26）。与非他汀类药物组相比，接受普伐他汀治疗的患者第二癌症风险显著升高（aHR 2.71，95% CI 1.19-6.19），而接受多种他汀类药物治疗（aHR 0.45，95% CI 0.25-0.81）和联合亲脂性和亲水性他汀类药物（aHR 0.42，95% CI 0.20-0.89）的患者第二癌症风险降低。接受累积定义日剂量（cDDD）>430 的患者风险较低（aHR 0.41，95% CI 0.19-0.86）。
本研究表明，在乳腺癌患者中，他汀类药物的使用与第二癌症风险之间关联不大。
