Influence of Statins and Cholesterol on Mortality Among Patients With Pancreatic Cancer
Influence of Statins and Cholesterol on Mortality Among Patients With Pancreatic Cancer
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DOI：
10.1093/jnci/djw275
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发表时间：
2017-05-01
影响因子：
10.3
通讯作者：
Wu, Bechien U.
中科院分区：
文献类型：
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作者：
Huang, Brian Z.;Chang, Jonathan I.;Wu, Bechien U.
背景：最近的研究表明他汀类药物与提高胰腺导管腺癌 (PDAC) 患者的生存率之间存在关联。然而，他汀类药物、胆固醇和生存之间的关系仍不清楚。 方法：我们对 2006 年至 2014 年区域综合医疗保健系统中的 2142 名 PDAC 患者进行了回顾性队列研究。电子药房记录用于提取诊断前一年开始的他汀类药物暴露类型、持续时间和剂量信息。使用 Cox 比例风险回归评估辛伐他汀、洛伐他汀、阿托伐他汀、普伐他汀和瑞舒伐他汀对死亡率的累积和个体影响。他汀类药物的评估分为任意使用（诊断前和诊断后作为时间相关变量）和基线使用（仅诊断前）。我们还评估了诊断前不同时间窗口测量的低密度脂蛋白（LDL）胆固醇是否对生存有独立影响。还进行了其他分析来检查胆固醇是否介导他汀类药物与死亡率之间的关系。所有模型均将年龄、种族、分期、手术、基于吉西他滨的化疗和 Charlson 合并症指数作为协变量。 结果：任何（风险比 [HR] = 0.87，95% 置信区间 [CI] = 0.79 至 0.97）和基线（HR = 0.88，95% CI = 0.79 至 0.98）他汀类药物的使用均与死亡率风险降低相关。在评估个体他汀类药物时，我们发现辛伐他汀（HR = 0.87，95% CI = 0.77至0.98）和阿托伐他汀（HR = 0.58，95% CI = 0.46至0.72）使用者的死亡率降低。胆固醇与死亡率无关，也不介导他汀类药物与生存之间的任何关系。结论：他汀类药物的使用而不是胆固醇水平与胰腺癌患者较低的死亡风险相关。他汀类药物似乎通过脂质独立机制来提高生存率。
Background: Recent studies have suggested associations between statins and enhanced survival among patients with pancreatic ductal adenocarcinoma (PDAC). However, the relationship between statins, cholesterol, and survival remains unclear.Methods: We conducted a retrospective cohort study on 2142 PDAC patients in a regional integrated healthcare system from 2006 to 2014. Electronic pharmacy records were used to abstract information on the type, length, and dosage of statin exposures starting in the year prior to diagnosis. The cumulative and individual effects of simvastatin, lovastatin, atorvastatin, pravastatin, and rosuvastatin on mortality were assessed using Cox proportional hazards regression. Statins were evaluated as any use (pre- and postdiagnosis as a time-dependent variable) and baseline use (prediagnosis only). We also evaluated whether low-density lipoprotein (LDL) cholesterol, measured at various time windows prior to diagnosis, had an independent influence on survival. Additional analyses were performed to examine whether cholesterol mediated the relationship between statins and mortality. All models included age, race, stage, surgery, gemcitabine-based chemotherapy, and the Charlson comorbidity index as covariates.Results: Any (hazard ratio [HR] = 0.87, 95% confidence interval [CI] = 0.79 to 0.97) and baseline (HR = 0.88, 95% CI = 0.79 to 0.98) statin use were both associated with a decreased risk in mortality. When assessing individual statins, we found reduced mortality among simvastatin (HR = 0.87, 95% CI = 0.77 to 0.98) and atorvastatin (HR = 0.58, 95% CI = 0.46 to 0.72) users. Cholesterol was not associated with mortality and did not mediate any relationships between statins and survival.Conclusions: Statin use rather than cholesterol level was associated with lower mortality risk in patients with pancreatic cancer. Statins appear to improve survival through a lipid-independent mechanism.