Statin use after diagnosis is associated with an increased survival in esophageal cancer patients: a Belgian population-based study

Lacroix, Olivia; Couttenier, Alexandra; Vaes, Evelien; Cardwell, Christopher; Schutter, Harlinde De; Robert, Annie

doi:10.1007/s10552-019-01149-3

Cited by 18 publications

(22 citation statements)

References 34 publications

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“…After excluding 11,579 records based on reviewing the title and abstract, 118 potentially relevant records remained for further review. A total of five cohort studies comprising 24,576 patients met the inclusion criteria after excluding 113 investigations identified as inadequate ( Supplementary Table 2 ) 25–29Figure 1 shows the flowchart of the study selection.…”

Section: Resultsmentioning

confidence: 99%

“…Two were conducted in North America, two in the United Kingdom, and the remaining one was from Belgium. Details of follow-up duration were available in Chris et al, George et al, and Lacroix et al, with median follow-up times ranging from 2 to 3.3 years 26,27,29. Data for OS and DFS were reported in all included studies, and these outcomes were reported both before and after adjustment in most studies.…”

Section: Resultsmentioning

confidence: 99%

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<p>Statin use and its potential therapeutic role in esophageal cancer: a systematic review and meta-analysis</p>

Zhou¹,

Zhong²,

Gao³

et al. 2019

CMAR

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Purpose: Statins, known as inhibitors of 3-hydroxy-3-methylglutaryl-coenzyme A (HMG CoA) reductases, are designed to treat lipid disorders, especially hypercholesterolemia. Apart from their role in preventing heart diseases in patients with high cholesterol, recent evidence suggests that statins have anti-tumor properties. However, studies assessing the association between statin use and esophageal cancer survival outcomes have provided controversial results. Methods: We conducted a systematic review and meta-analysis focusing on studies evaluating associations between statin use and survival outcomes for esophageal cancer patients. Results: A total of five cohort studies comprising 24,576 patients were included. Statin use associated with improved overall survival (OS: HR 0.84, 95% CI, 0.75–0.94) and disease-free survival (DFS: HR 0.84, 95% CI, 0.75–0.96) of esophageal cancer patients. The improved survival outcomes were consistent in the esophageal adenocarcinoma subgroup and the esophageal squamous cell cancer subgroup. Conclusion: A potential therapeutic role of statins in esophageal cancer has been demonstrated in our study, however, the results should be interpreted cautiously and need further confirmation by future studies.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

<p>Statin use and its potential therapeutic role in esophageal cancer: a systematic review and meta-analysis</p>

Zhou¹,

Zhong²,

Gao³

et al. 2019

CMAR

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“…One systematic review focusing on all types of cancers was excluded [15] and another 2 studies exploring the impact of statin use on either short-term outcomes [16] or cost-utility effects [17] in surgically treated esophageal cancer patients were also excluded. Finally, we included a total of 4 cohort studies [7–10] involving a total of 20,435 esophageal cancer patients (5319 statin users and 15116 non-users) for meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

“…The follow-up was actually relatively long even though the absolute time of follow-up time was not given out in some studies. [7–10] All studies had a relatively large sample size and appropriate adjustment for comparing survival between statin users and non-users. The main data for meta-analysis extracted from each included study were presented in Table 2.…”

Section: Resultsmentioning

confidence: 99%

“…[6] However, as for the impact of statins on survival of esophageal cancer patients, previous studies have drawn conflicting conclusions due to various biases. [7–10] Some studies found that statin use was significantly correlated with decreased all-cause and cancer-specific mortality in esophageal cancer patients with both EA and esophageal SCC [9] while others found that statin use had little evidence of cancer-specific mortality reduction in esophageal cancer patients. [8] Moreover, some even found that statin use could only reduce the all-cause and cancer-specific mortality in patients with EA but not in patients with esophageal SCC.…”

Section: Introductionmentioning

confidence: 99%

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The association between statin use and survival of esophageal cancer patients

Deng¹,

Lan²,

Zheng³

et al. 2019

Medicine

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Whether statin use has any impact on survival of esophageal cancer patients remains controversial. Therefore, we conducted a meta-analysis focusing on current topic for the first time. We systematically searched the following databases for relevant studies comparing survival between statin users and non-users among esophageal cancer patients up to March 16, 2019: Pubmed, Embase, and Web of Science. We extracted data of hazard ratio (HR) with 95%confidence interval (CI) of all-cause and cancer-specific mortality for analysis. We used the STATA 12.0 software to perform this meta-analysis. We finally included a total of 4 cohort studies involving a total of 20,435 esophageal cancer patients (5319 statin users and 15116 non-users). Our meta-analysis found that statin use after diagnosis of esophageal cancer was significantly correlated to decreased all-cause (random effects: HR = 0.81, 95%CI: 0.75–0.89, P < .001; I 2 = 68.1%) and cancer-specific mortality (fixed effects: HR = 0.84, 95%CI: 0.78–0.89, P < .001; I 2 = 46.6%) in esophageal cancer patients. When stratified by pathological subtypes, the protective effect of statin use after diagnosis of esophageal cancer was observed in both esophageal adenocarcinoma patients and esophageal squamous cell carcinoma patients. Moreover, statin use before diagnosis of esophageal cancer was also confirmed to have favorable survival benefit for esophageal cancer patients. Statin use was significantly correlated to lower mortality risk of esophageal cancer patients regardless of the time when statins were taken and pathological subtypes of esophageal cancer. Statins may serve as promising adjunctive anticancer agents for treating esophageal cancer.

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Adjuvant statin therapy for oesophageal adenocarcinoma: the STAT-ROC feasibility study

Alexandre

Clark

Walton³

et al. 2020

BJS Open

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Background: Statins inhibit proliferative signalling in oesophageal adenocarcinoma (OAC) and their use is associated with better survival in observational studies. The present study was undertaken to examine the feasibility of assessing adjuvant statin therapy in patients with operable OAC in a phase III RCT.Methods: For this multicentre, double-blind, parallel-group, randomized, placebo-controlled feasibility trial, adults with OAC (including Siewert I-II lesions) who had undergone oesophagectomy were centrally allocated (1 : 1) to simvastatin 40 mg or matching placebo by block randomization, stratified by centre. Participants, clinicians and investigators were blinded to treatment allocation. Patients received treatment for up to 1 year. Feasibility outcomes were recruitment, retention, drug absorption, adherence, safety, quality of life, generalizability and survival.Results: A total of 120 patients were assessed for eligibility at four centres, of whom 32 (26⋅7 per cent) were randomized, 16 in each group. Seven patients withdrew. Participants allocated to simvastatin had lower low-density lipoprotein cholesterol levels by 3 months (adjusted mean difference −0⋅83 (95 per cent c.i. −1⋅4 to −0⋅22) mmol/l; P = 0⋅009). Median adherence to medication was greater than 90 per cent between 3 and 12 months' follow-up. Adverse events were similar between the groups. Quality-of-life data were complete for 98⋅3 per cent of questionnaire items. Cardiovascular disease, diabetes and aspirin use were more prevalent in the non-randomized group, whereas tumour site, stage and grade were similar between groups. Survival estimates were imprecise.Conclusion: This RCT supports the conduct and informs the design considerations for a future phase III trial of adjuvant statin therapy in patients with OAC. Registration number: ISRCTN98060456 (www.isrctn/com).

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Statin use after diagnosis is associated with an increased survival in esophageal cancer patients: a Belgian population-based study

Cited by 18 publications

References 34 publications

<p>Statin use and its potential therapeutic role in esophageal cancer: a systematic review and meta-analysis</p>

<p>Statin use and its potential therapeutic role in esophageal cancer: a systematic review and meta-analysis</p>

The association between statin use and survival of esophageal cancer patients

Adjuvant statin therapy for oesophageal adenocarcinoma: the STAT-ROC feasibility study

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