Division of Urology, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
Cardio-Oncology Research Unit, Cardiovascular Analytics Group, PowerHealth Limited, Hong Kong, China.
Cancer Med. 2024 Jan;13(1):e6826. doi: 10.1002/cam4.6826. Epub 2023 Dec 22.
This study aimed to examine the associations between the use of statins concurrent with androgen deprivation therapy (ADT) and the risks of mortality in Asian patients diagnosed with prostate cancer (PCa).
Adult patients (≥18 years old) diagnosed with PCa who were receiving any form of ADT and were being treated at public hospitals in Hong Kong from December 1999 to March 2021 were retrospectively identified, with follow-up conducted until September 2021. Patients who had received medical castration for <180 days without subsequent bilateral orchidectomy, those who had used statins concurrently with ADT for <180 days, and those with missing baseline total cholesterol levels were excluded. Statin users were defined as individuals who had used statins for ≥180 days concurrent with ADT, while non-users were those who had not used any statins. PCa-related mortality was the primary outcome, while all-cause mortality served as the secondary outcome. Inverse probability treatment weighting was employed to balance the covariates.
A total of 4920 patients were included, consisting of 2578 statin users and 2342 non-users (mean age 76.1 ± 8.2 years). Over a mean follow-up period of 4.2 ± 3.3 years, it was observed that statin users had significantly lower risks of both PCa-related mortality (weighted hazard ratio [wHR] 0.56 [95% confidence interval (CI) 0.48, 0.65], p < 0.001) and all-cause mortality (wHR 0.57 [95% CI 0.51, 0.63], p < 0.001), regardless of the type of ADT used. Notably, these associations were more pronounced among patients with less advanced PCa, as indicated by the absence of androgen receptor antagonist or chemotherapy usage (p value for interaction <0.001 for both outcomes).
CONCLUSION(S): The use of statins concurrent with ADT was associated with reduced mortality risks among Asian patients with PCa. These findings suggest the need for additional research to explore the potential role of statins in the treatment of PCa patients.
本研究旨在探讨在亚洲前列腺癌（PCa）患者中，同时使用他汀类药物和雄激素剥夺治疗（ADT）与死亡率风险之间的关联。
回顾性确定了 1999 年 12 月至 2021 年 3 月期间在香港公立医院接受任何形式 ADT 治疗的成年（≥18 岁）PCa 患者，并进行随访至 2021 年 9 月。排除了接受医学去势治疗<180 天且未随后进行双侧睾丸切除术、同时使用 ADT 和他汀类药物<180 天且基线总胆固醇水平缺失的患者。将使用他汀类药物≥180 天同时使用 ADT 的患者定义为他汀类药物使用者，未使用任何他汀类药物的患者定义为非使用者。PCa 相关死亡率为主要结局，全因死亡率为次要结局。采用逆概率治疗加权法来平衡协变量。
共纳入 4920 例患者，其中 2578 例为他汀类药物使用者，2342 例为非使用者（平均年龄 76.1±8.2 岁）。在平均 4.2±3.3 年的随访期间，与非使用者相比，他汀类药物使用者的 PCa 相关死亡率（加权风险比[wHR]0.56[95%置信区间（CI）0.48,0.65]，p<0.001）和全因死亡率（wHR 0.57[95%CI 0.51,0.63]，p<0.001）风险显著降低，无论使用何种类型的 ADT 治疗。值得注意的是，在雄激素受体拮抗剂或化疗未使用的患者中（两个结局的交互作用 p 值均<0.001），这些关联更为显著。
在亚洲 PCa 患者中，同时使用他汀类药物和 ADT 与死亡率风险降低相关。这些发现提示需要进一步研究探索他汀类药物在治疗 PCa 患者中的潜在作用。
