Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.
Prevention Division, Queensland Health, Brisbane, QLD, Australia.
Br J Clin Pharmacol. 2021 Apr;87(4):1847-1858. doi: 10.1111/bcp.14573. Epub 2020 Oct 20.
Inconclusive findings of lipid-lowering medications (LLMs) on cancer survival benefit require more evidence. We tested the hypothesis that adherence to this drug is associated with reduced cancer-specific mortality in a homogeneous population who had used this drug before cancer diagnosis.
The Australian Cancer Database was linked to the Pharmaceutical Benefits Scheme database, and to the National Death Index (up to 2015). Medication adherence was calculated by proportion of days covered. Cox regression models with time-varying covariates were used to derive multivariable-adjusted cause-specific hazard ratio (HR) and 95% confidence interval (CI) for the associations between adherence to LLMs, statins, lipophilic, and hydrophilic statins and cancer-specific mortality.
From 2003 to 2013, 3 separate cohorts of 20 046, 11 719 and 6430 female patients with newly diagnosed breast, colorectal cancer, and melanoma respectively were identified. The 1-year adherence was similar at 1-year prediagnosis in the 3 cohorts, on average 82%. Each 10% increase in 1-year adherence to LLMs was inversely associated with cancer-specific mortality among women with breast cancer (fully adjusted HR = 0.92, 95% CI 0.91-0.93), colorectal cancer (fully adjusted HR = 0.92, 95% CI 0.91-0.93), or melanoma (fully adjusted HR = 0.97, 95% CI 0.94-1.00). The reductions in cancer-specific mortality were more pronounced for women who adhered to lipophilic than hydrophilic statins in all 3 cancers albeit not statistically significant for melanoma.
Among LLM users, adherence to this drug is associated with a decrease in cancer-specific mortality. If confirmed, LLMs could be considered as an adjuvant cancer therapy to improve prognosis in cancer survivors.
降脂药物（LLMs）在癌症生存获益方面的不确定结果需要更多的证据。我们检验了一个假设，即在使用该药之前被诊断患有癌症的同质人群中，坚持使用这种药物与降低癌症特异性死亡率有关。
澳大利亚癌症数据库与药品福利计划数据库以及国家死亡索引（截至 2015 年）相关联。通过覆盖天数的比例计算药物依从性。使用时变协变量的 Cox 回归模型得出多变量调整后的特定原因风险比（HR）和 95%置信区间（CI），用于评估 LLMs、他汀类药物、亲脂性和亲水性他汀类药物与癌症特异性死亡率之间的关系。
2003 年至 2013 年，分别确定了 3 个队列，每个队列分别有 20046 例、11719 例和 6430 例新诊断为乳腺癌、结直肠癌和黑色素瘤的女性患者。3 个队列在诊断前 1 年的 1 年依从率相似，平均为 82%。LLMs 的 1 年依从率每增加 10%，与乳腺癌（完全调整后的 HR = 0.92，95%CI 0.91-0.93）、结直肠癌（完全调整后的 HR = 0.92，95%CI 0.91-0.93）或黑色素瘤（完全调整后的 HR = 0.97，95%CI 0.94-1.00）女性的癌症特异性死亡率呈反比关系。在所有 3 种癌症中，亲脂性他汀类药物的依从性比亲水性他汀类药物对癌症特异性死亡率的降低更为显著，尽管对黑色素瘤来说并不具有统计学意义。
在 LLM 使用者中，坚持使用该药与癌症特异性死亡率降低有关。如果得到证实，LLMs 可以被视为改善癌症幸存者预后的辅助癌症治疗方法。
