Graduate School of Biomedical Science, University of Texas Medical Branch, Galveston, TX, USA.
School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA.
Cancer Epidemiol. 2024 Oct;92:102633. doi: 10.1016/j.canep.2024.102633. Epub 2024 Aug 21.
Statins and testosterone replacement therapy (TTh) have been inconsistently associated with a reduced risk of hormone-related cancers (HRCs, prostate [PCa], colorectal [CRC], and male breast cancers [BrCa]). Yet, the joint association of statins and TTh with the incidence of these cancers, and whether these associations vary by race, remains poorly understood. The objective of this retrospective cohort study is to examine the independent and joint effects of pre-diagnostic use of statins and TTh on the risk of HRCs, including PCa, CRC, and male BrCa.
and Methods: In 105,690 men (≥65 yrs) identified using the SEER-Medicare 2007-2015 data, we identified 82,578 White and 10,256 Black men. Pre-diagnostic prescription of statins and TTh was ascertained for this analysis and categorized into four groups (Neither users, statins alone, TTh alone and Dual users). Multivariable Time-varying Cox proportional hazards and Accelerated Failure Time (AFT) models were performed.
We found inverse joint associations of statins and TTh with incident HRCs before (aHR: 0.39; 95 % CI: 0.35-0.44) and after 3 years of follow-up (aHR: 0.74; 95 % CI: 0.67-0.82). This included a lower risk for advanced stage HRC (only <3 years follow-up). Similar joint associations were identified with incident PCa, aggressive PCa, incident CRC, and its specific right- and left-sided CRC (only <3 years follow-up). In general, the inverse associations persisted among White (mainly <3 years follow-up) and Black men (high-grade HRC and <3 years follow-up). Findings from the AFT analysis were similar.
Pre-diagnostic use of statins and TTh were, independently and jointly, associated with reduced risks of HRC and specific cancer sites at three years of follow-up overall, and among White and Black men. Greatest associations of HRCs risk reduction were observed among dual users (statins plus TTh). Further studies are needed to validate these findings, including larger samples of Black men, and male BrCa sites.
他汀类药物和睾丸激素替代疗法（TTh）与激素相关癌症（HRC，前列腺癌[PCa]，结直肠癌[CRC]和男性乳腺癌[BrCa]）的风险降低有关，但尚不清楚他汀类药物和 TTh 的联合使用与这些癌症的发病风险之间的关系，以及这些关联是否因种族而异。本回顾性队列研究的目的是研究预先诊断使用他汀类药物和 TTh 对 HRC（包括 PCa、CRC 和男性 BrCa）风险的独立和联合影响。
在使用 SEER-Medicare 2007-2015 年数据确定的 105690 名男性（≥65 岁）中，我们确定了 82578 名白人男性和 10256 名黑人男性。为了进行这项分析，我们确定了预先诊断处方他汀类药物和 TTh 的情况，并将其分为四组（均未使用者、单独使用他汀类药物、单独使用 TTh 和联合使用者）。使用多变量时间变化 Cox 比例风险和加速失效时间（AFT）模型进行分析。
我们发现他汀类药物和 TTh 的联合使用与预先诊断后 HRC 的发生呈负相关（aHR：0.39；95%CI：0.35-0.44）和 3 年随访后（aHR：0.74；95%CI：0.67-0.82）。这包括晚期 HRC（仅<3 年随访）的风险降低。与 PCa、侵袭性 PCa、CRC 及其特定右侧和左侧 CRC（仅<3 年随访）的发病风险也有类似的联合关联。一般来说，白人（主要是<3 年随访）和黑人男性（高级别 HRC 和<3 年随访）的这种负相关关系仍然存在。AFT 分析的结果相似。
预先诊断使用他汀类药物和 TTh 与 HRC 和特定癌症部位的风险降低独立且联合相关，在总体随访 3 年时以及在白人男性和黑人男性中均如此。联合使用（他汀类药物加 TTh）时，HRC 风险降低的关联最大。需要进一步的研究来验证这些发现，包括更大的黑人男性样本和男性 BrCa 部位。
