Department of Medical Oncology, The Affiliated Hospital of Jiangnan University, Wuxi, China.
Department of General Surgery, The Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, Wuxi, 214002, China.
Arch Gynecol Obstet. 2021 Nov;304(5):1315-1321. doi: 10.1007/s00404-021-06065-z. Epub 2021 Apr 23.
Preclinical studies and epidemiologic data had indicated statins had antineoplastic properties in breast cancer patients. Since breast cancer treatment is based on its phenotype, it is important to explore influence of post-diagnosis statin usage on breast cancer patients with different phenotypes.
We searched the related studies between inception and August, 2019 from MEDLINE and EMBASE. A total of 7 studies with 24,541 patients were identified. Stata/SE 15.0 and Review Manager 5.3 were used to analyze data. Inconsistency index was used to estimate heterogeneity. Begg's and Egger's regression test was used to examine publication bias.
Overall post-diagnostic statin use was associated with improved recurrence free survival (recurrence free survival (RFS); hazard ratio (HR) 0.74; 95% confidential interval (95% CI) 0.57-0.98), overall survival (overall survival (OS); HR 0.53; 95% CI 0.31-0.91) and cancer-specific survival (cancer-specific survival (CSS); and HR 0.61; 95% CI 0.41-0.91). In hormone receptor positive patients, statin use was associated with improved CSS (HR 0.74, 95% CI 0.65-0.84). No protective effect was found in either OS or RFS. In hormone receptor negative patients, statin was associated with reduced OS (HR 2.19, 95% CI 1.34-3.59) and reduced RFS, but without statistical significance.
Post-diagnostic statin use was associated with improved RFS, OS and CSS in breast cancer patients. Subgroup analysis indicted that the benefits of statin usage varied from hormone receptor phenotype type. Prospective randomized trial with patients of different hormone receptor types might be needed to help identify which subtype of breast cancer patients would benefit from post-diagnostic statin usage.
临床前研究和流行病学数据表明他汀类药物对乳腺癌患者具有抗肿瘤特性。由于乳腺癌的治疗基于其表型，因此探索诊断后使用他汀类药物对具有不同表型的乳腺癌患者的影响非常重要。
我们从 MEDLINE 和 EMBASE 中检索了从建立到 2019 年 8 月的相关研究。共确定了 7 项研究，涉及 24541 名患者。使用 Stata/SE 15.0 和 Review Manager 5.3 分析数据。使用不一致指数来评估异质性。使用 Begg 和 Egger 回归检验来检查发表偏倚。
总体而言，诊断后使用他汀类药物与改善无复发生存率（无复发生存率（RFS）；风险比（HR）0.74；95%置信区间（95%CI）0.57-0.98）、总生存率（总生存率（OS）；HR 0.53；95%CI 0.31-0.91）和癌症特异性生存率（癌症特异性生存率（CSS）；HR 0.61；95%CI 0.41-0.91）相关。在激素受体阳性患者中，他汀类药物的使用与改善 CSS（HR 0.74，95%CI 0.65-0.84）相关。在 OS 或 RFS 中未发现保护作用。在激素受体阴性患者中，他汀类药物与 OS（HR 2.19，95%CI 1.34-3.59）和 RFS 降低相关，但无统计学意义。
诊断后使用他汀类药物与乳腺癌患者的 RFS、OS 和 CSS 改善相关。亚组分析表明，他汀类药物使用的益处因激素受体表型类型而异。需要对不同激素受体类型的患者进行前瞻性随机试验，以帮助确定哪种类型的乳腺癌患者将从诊断后使用他汀类药物中受益。
