Statin use and survival in patients with gastric cancer in two independent population‐based cohorts

Abstract

Purpose Preclinical studies show statins inhibit pathways involved in gastric cancer progression, with observational studies demonstrating reduced gastric cancer risk in statin users. However, few studies have investigated statin use and survival in gastric cancer. We investigated statin use and survival in two large population‐based gastric cancer cohorts. Methods Patients diagnosed with gastric cancer from 1998 to 2012 were identified from English and Scottish cancer registries. Statin prescriptions were identified from linkages to the UK Clinical Practice Research Datalink in England and the Prescribing Information System in Scotland, and deaths identified from national mortality records. Time‐dependent Cox regression models were used to calculate hazard ratios (HR) and 95% confidence intervals (CIs) for cancer‐specific mortality by statin use in multivariate analysis. Meta‐analysis techniques pooled results across the cohorts. Results The combined cohorts contained 3833 patients with gastric cancer and 2392 cancer‐specific deaths. Statin use after diagnosis was associated with reduced cancer‐specific mortality (adjusted HR 0.83; 95% CI, 0.74‐0.92). HRs for less than 1 year and over 1 year of statin use were similar (adjusted HR 0.83; 95% CI, 0.73‐0.94 and adjusted HR 0.83; 95% CI, 0.64‐1.01, respectively). Statin use prior to diagnosis was also associated with reduced cancer‐specific mortality (adjusted HR 0.91; 95% CI, 0.84‐0.98). Conclusions In two independent UK cohorts, there was some evidence that statin use was associated with reduced cancer‐specific mortality. However, these associations were weak in magnitude and did not follow a clear dose response, and we cannot rule out confounding by stage.

Statin Use Improves Overall Survival of Patients with Gastric Cancer after Surgery and Adjuvant Chemotherapy in Taiwan: A Nationwide Matched Cohort Study

“…All-cause mortality (HR 0.17; 95% CI, 0.03-0.88) and recurrence-free survival (HR 0.37; 95% CI, 0.10-1.37) in long-term statin users who had been administered statins for more than 6 months were more positive than in short-term users (<6 months) [20]. Another independent UK cohort study demonstrated decreased cancer-specific mortality (adjusted HR 0.83; 95% CI, 0.74-0.92) in GC patients with statin use [19]. In our study, a notable dose-response relationship was observed between statin use and the OS of patients with GC post surgery and adjuvant chemotherapy.…”

“…Few studies have investigated how statin use improves survival and outcomes after GC diagnosis. One study observed a 17% decrease in the cancer-related death in the United Kingdom [19], and another study revealed an 83% decrease in all-cause mortality after six months of statin use in Korea [20].…”

Statin therapy and gastric cancer death

“…Some points not shown in the original article are discussed. The cancer-specific death rate of gastric cancer was lower in subjects with statin use than those without use in Spence et al ’s study (37.80 vs 42.07 per 100 person-years) 3. A preliminary estimation revealed that the absolute risk reduction is about 0.0427.…”

“…The association between statin use and gastric cancer risk has been extensively assessed 1 2. Recently, a cohort study in UK conducted by Spence et al revealed that statin use after a diagnosis of gastric cancer was associated with a lower hazard of cancer-specific death (HR=0.83, 95% CI 0.74 to 0.93) 3. This result was partially compatible with that of a cohort study in Republic of Korea showing that statin use for more than 6 months was associated with increased survival rate of gastric cancer compared with non-use (HR=0.168, 95% CI 0.032 to 0.881) 4.…”

Improving prescribing through big data approaches—Ten years of the Scottish Prescribing Information System

“…A total of 267 publications were identified over the period January 2009 to March 2019. After screening titles and abstracts, and removing duplicates and conference abstracts, 40 full publication articles were included and reviewed . The number of articles published by year for the period 2014–2018, totalling 37, is presented in Figure A; a further 3 studies were published in the first months of 2019.…”