Impact of statin use on survival in patients undergoing resection for early-stage pancreatic cancer.
Impact of statin use on survival in patients undergoing resection for early-stage pancreatic cancer.
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DOI：
10.1038/ajg.2015.217
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发表时间：
2015-08
期刊：
影响因子：
--
通讯作者：
Cooper RM
中科院分区：
文献类型：
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作者：
Wu BU;Chang J;Jeon CY;Pandol SJ;Huang B;Ngor EW;Difronzo AL;Cooper RM
他汀类药物具有潜在的抗肿瘤作用。他汀类药物的使用与胰腺癌预后之间的关系存在争议。我们假设基线时使用他汀类药物会影响早期胰腺癌患者的生存率，并且这种影响可能因他汀类药物而异。我们对来自综合医疗保健系统的数据进行了回顾性队列研究。我们纳入了2005年1月至2011年1月期间因根治性目的而接受切除术的I-IIb期胰腺癌患者。基线他汀类药物使用的特征是任何先前使用以及积极使用辛伐他汀或洛伐他汀。暴露强度计算为手术前的平均日剂量。评估从手术至研究结束（2014年4月）的总生存期和无疾病生存期。我们使用Kaplan-Meier方法和考克斯比例风险回归来评估基线他汀类药物使用对生存率的影响，调整年龄，性别，Charlson合并症评分，切除边缘，疾病分期和接受辅助化疗。在226例患者中，基线时71例（31.4%）既往使用辛伐他汀，27例（11.9%）既往使用洛伐他汀。既往使用辛伐他汀而非洛伐他汀与生存期改善相关（辛伐他汀的中位生存期为28.5个月（95%置信限（CL）20.8，38.4），洛伐他汀为12.9个月（9.6，15.5），非他汀类药物使用者为16.5个月（14.1，18.9）;对数秩P=0.0035）。在考克斯回归分析中，积极使用辛伐他汀与死亡风险降低（校正的风险比（HR）0.56（95% CL 0.38，0.83），P=0.004）和复发风险降低（校正的HR 0.61（0.41，0.89），P=0.01）独立相关。与接受低强度辛伐他汀治疗的患者相比，接受中-高强度辛伐他汀治疗的患者（中位时间为42.1个月（24.0，52.7））的生存期显著改善（中位时间为14.1个月（8.6，23.8），对数秩P=0.03）。他汀类药物的作用因药物和剂量而异。在接受胰腺癌切除术的患者中，在基线时积极使用中高剂量辛伐他汀与改善总体和无病生存率相关。
It has been suggested that statins exert potential anti-tumor effects. The relationship between statin use and outcomes in pancreatic cancer is controversial. We hypothesized that statin use at baseline would impact survival among patients with early-stage pancreatic cancer and that the effect might vary by individual statin agent. We conducted a retrospective cohort study on data from an integrated healthcare system. We included patients with pancreatic cancer stage I-IIb who underwent resection for curative intent between January 2005 and January 2011. Baseline statin use was characterized as any prior use as well as active use of either simvastatin or lovastatin. Intensity of exposure was calculated as average daily dose prior to surgery. Overall and disease-free survival was assessed from surgery until the end of study (April 2014). We used the Kaplan-Meier method and Cox proportional hazards regression to evaluate the impact of baseline statin use on survival, adjusting for age, sex, Charlson comorbidity score, resection margin, disease stage, and receipt of adjuvant chemotherapy. Among 226 patients, 71 (31.4%) had prior simvastatin use and 27 (11.9%) had prior lovastatin use at baseline. Prior simvastatin but not lovastatin use was associated with improved survival (median 28.5 months (95% confidence limit (CL) 20.8, 38.4) for simvastatin vs. 12.9 months (9.6, 15.5) for lovastatin vs. 16.5 months (14.1, 18.9) for non-statin users; log-rank P=0.0035). In Cox regression, active simvastatin use was independently associated with reduced risk for mortality (adjusted hazard ratio (HR) 0.56 (95% CL 0.38, 0.83), P=0.004) and risk for recurrence (adjusted HR 0.61 (0.41, 0.89), P=0.01). Survival improved significantly among patients who received moderate-high-intensity (median 42.1 months (24.0,52.7)) doses compared with those who received low-intensity doses of simvastatin (median 14.1 months (8.6, 23.8), log-rank P=0.03). The effects of statins varied by agent and dose. Active use of moderate-high-dose simvastatin at baseline was associated with improved overall and disease-free survival among patients undergoing resection for pancreatic cancer.