The association between statin medication and progression after surgery for localized renal cell carcinoma.
The association between statin medication and progression after surgery for localized renal cell carcinoma.
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DOI：
10.1016/j.juro.2013.10.141
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发表时间：
2014-04
影响因子：
6.6
通讯作者：
Russo, Paul
中科院分区：
文献类型：
--
作者：
Hamilton, Robert J.;Morilla, Daniel;Cabrera, Fernando;Leapman, Michael;Chen, Ling Y.;Bernstein, Melanie;Hakimi, A. Ari;Reuter, Victor E.;Russo, Paul
关键词：
有证据表明他汀类药物可能会影响RCC增殖的途径，尽管没有研究检查他汀类药物对人类RCC进展的影响。我们确定了1995-2010年间在我们的三级转诊中心接受手术治疗的2608例局部RCC患者。竞争风险考克斯比例风险模型用于评估他汀类药物使用与局部复发或进展（RCC转移或死亡）时间和总生存期之间的关系。作为敏感性分析，他汀类药物的使用被建模为时间依赖性协变量。根据临床和人口统计学特征调整模型。在2608例患者中，699例（27%）在手术时使用他汀类药物。他汀类药物使用者与非使用者有相似的病理特征。中位随访时间为36个月，共有247例进展事件。他汀类药物的使用与术后进展风险降低33%（HR 0.67，95% CI 0.47-0.96，p=0.028）和总体死亡率降低11%相关，但不显著（HR 0.89，95% CI 0.71-1.13，p=0.3）。将他汀类药物作为时间依赖性协变量进行建模，使进展风险降低至23%（HR 0.77，p=0.12），并增加了总生存率的风险降低（HR 0.71; p=0.002）。在我们的队列中，他汀类药物的使用与疾病进展和总体死亡率的风险降低相关，尽管这种影响对分析方法敏感。如果在其他队列中得到验证，这一发现值得考虑他汀类药物辅助治疗的前瞻性研究。
Evidence suggests statins may influence pathways of RCC proliferation, though no study has examined the influence of statin medications on progression of RCC in humans. We identified 2608 patients with localized RCC who were treated surgically between 1995–2010 at our tertiary referral center. Competing risks Cox proportional hazards models were used to evaluate the relationship between statin use and time to local recurrence or progression (metastases or death from RCC) and overall survival. Statin use was modeled as a time-dependent covariate as a sensitivity analysis. Models were adjusted for clinical and demographic features. Of 2608 patients, 699 (27%) were statin users at surgery. Statin users had similar pathological characteristics compared to nonusers. With a median follow-up of 36 months, there were 247 progression events. Statin use was associated with a 33% reduction in the risk of progression after surgery (HR 0.67, 95% CI 0.47–0.96, p=0.028) and an 11% reduction in overall mortality that was not significant (HR 0.89, 95% CI 0.71–1.13, p=0.3). Modeling statin use as time-dependent covariate attenuated the risk reduction in progression to 23% (HR 0.77, p=0.12) and augmented the risk reduction in overall survival (HR 0.71; p=0.002). In our cohort, statin use was associated with a reduced risk of progression and overall mortality, though this effect was sensitive to method of analysis. If validated in other cohorts, this finding warrants consideration of prospective research on statins in the adjuvant setting.
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影响因子：
3.4
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影响因子：
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