他汀类药物与胆道癌风险降低相关：系统评价和荟萃分析。
Statins associate with lower risk of biliary tract cancers: A systematic review and meta-analysis.
机构信息
Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
出版信息
Cancer Med. 2023 Jan;12(1):557-568. doi: 10.1002/cam4.4942. Epub 2022 Jun 13.
BACKGROUND
Biliary tract cancers (BTCs), encompassing cholangiocarcinoma (CCA), gallbladder (GBC), and ampulla of Vater cancers (AVC), are common hepatobiliary cancer after hepatocellular carcinoma with a high mortality rate. As there is no effective chemopreventive agent to prevent BTCs, this study aimed to explore the role of statins on the risk of BTCs.
METHODS
PubMed, Embase, and Cochrane Library from inception until 24 April 2020 were searched according to the Meta-Analyses of Observational Studies in Epidemiology (MOOSE) guidelines. The adjusted risk ratios (aRRs) of BTCs and individual cancer were pooled using a random-effects model.
RESULTS
Eight observational studies (3 cohort and 5 case-control studies) were included with 10,485,231 patients. The median age was 68.0 years (IQR: 67.0-71.5) and 48.3% were male. Statins were associated with a lower risk of all BTCs (aRR: 0.67; 95% CI: 0.51-0.87). The pooled aRR for CCA was 0.60 (95% CI: 0.38-0.94) and GBC was 0.78 (95% CI: 0.68-0.90). There was only one study on AVC with aRR of 0.96 (95% CI: 0.66-1.41). The pooled aRR for lipophilic and hydrophilic statins was 0.78 (95% CI: 0.69-0.88) and 0.70 (95% CI: 0.61-0.80), respectively. The effects were attenuated in studies that adjusted for aspirin and/or non-steroidal anti-inflammatory drugs (aRR: 0.80, 95% CI: 0.72-0.89) and metformin (aRR: 0.80, 95% CI: 0.72-0.90).
CONCLUSIONS
Statins, both lipophilic and hydrophobic, were associated with a lower risk of BTCs, particularly CCA and GBC.
背景
胆道癌（BTCs）包括胆管癌（CCA）、胆囊癌（GBC）和壶腹癌（AVC），是继肝细胞癌之后常见的肝胆癌，死亡率较高。由于目前尚无有效的化学预防药物来预防 BTCs，因此本研究旨在探讨他汀类药物对 BTCs 风险的作用。
方法
根据观察性研究的荟萃分析（MOOSE）指南，检索 PubMed、Embase 和 Cochrane Library 从成立到 2020 年 4 月 24 日的数据。使用随机效应模型对 BTCs 和个别癌症的调整风险比（aRR）进行汇总。
结果
纳入了 8 项观察性研究（3 项队列研究和 5 项病例对照研究），共纳入 10485231 名患者。中位年龄为 68.0 岁（IQR：67.0-71.5），48.3%为男性。他汀类药物与 BTCs 总体风险降低相关（aRR：0.67；95%CI：0.51-0.87）。CCA 的汇总 aRR 为 0.60（95%CI：0.38-0.94），GBC 为 0.78（95%CI：0.68-0.90）。仅有一项关于 AVC 的研究，其 aRR 为 0.96（95%CI：0.66-1.41）。亲脂性和亲水性他汀类药物的汇总 aRR 分别为 0.78（95%CI：0.69-0.88）和 0.70（95%CI：0.61-0.80）。在调整了阿司匹林和/或非甾体抗炎药（aRR：0.80，95%CI：0.72-0.89）和二甲双胍（aRR：0.80，95%CI：0.72-0.89）的研究中，效应减弱。
结论
亲脂性和疏水性他汀类药物均与 BTCs，尤其是 CCA 和 GBC 的风险降低相关。
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