Statin and the risk of hepatocellular carcinoma in patients with hepatitis B virus or hepatitis C virus infection: a meta-analysis

Abstract

Background: Statin may confer anticancer effect. However, the association between statin and risk of hepatocellular carcinoma (HCC) in patients with hepatitis B virus (HBV) or hepatitis C (HCV) virus infection remains inconsistent according to results of previous studies. A meta-analysis was performed to summarize current evidence. Methods: Related follow-up studies were obtained by systematic search of PubMed, Cochrane's Library, and Embase databases. A random-effect model was used to for the meta-analysis. Stratified analyses were performed to evaluate the influences of study characteristics on the outcome. Results: Thirteen studies with 519,707 patients were included. Statin use was associated with reduced risk of HCC in these patients (risk ratio [RR]: 0.54, 95% CI: 0.44 to 0.66, p < 0.001; I 2 = 86%). Stratified analyses showed that the association between statin use and reduced HCC risk was consistent in patients with HBV or HCV infection, in elder (≥ 50 years) or younger (< 50 years) patients, in males or females, in diabetic or non-diabetic, and in those with or without cirrhosis (all p < 0.05). Moreover, lipophilic statins was associated with a reduced HCC risk (RR: 0.52, p < 0.001), but not for hydrophilic statins (RR: 0.89, p = 0.21). The association was more remarkable in patients with highest statin accumulative dose compared to those with lowest accumulative dose (p = 0.002). Conclusions: Satin use was independently associated with a reduced risk of HCC in patients with HBV or HCV infection.

A systematic review on pharmacokinetics, cardiovascular outcomes and safety profiles of statins in cirrhosis

“…Initial search identified 15 studies. Search in the references of published systematic reviews [ 9 – 11 , 29 , 30 ] , did not identify additional articles. Search in the reference list of one review article [ 8 ] identified four additional articles.…”

Prevention of hepatitis B virus-related hepatocellular carcinoma

“…In the Swedish nationwide cohort including chronic hepatitis B and C patients, the use of lipophilic statins decreased the cumulative incidence of HCC (aHR: 0.41; 95%CI: 0.32-0.61) [78] . A recent meta-analysis, including 7 studies with HBV carriers revealed that statin therapy reduced the risk of HBVrelated HCC with a relative risk of 0.52 (95%CI: 0.40-0.68; P < 0.001) [79] .…”

Reply:

“…The definition of statin users (≥28‐30 cumulative defined daily dose) involves widely accepted criteria. ( 4 ) The limitations of the study prevented us from drawing definitive conclusions, but the study findings support the potential benefit to patients with chronic hepatitis B and warrant a further prospective and randomized controlled trial.…”