Statin use and survival with early stage hepatocellular carcinoma
A partir des données des registres américains des cancers portant sur 1 036 patients atteints d'un carcinome hépatocellulaire de stade I ou II, cette étude analyse l'association entre une utilisation de statines après le diagnostic et la survie (durée médiane de suivi : 21 mois)
Background: Limited clinical and epidemiological data suggest that statins may improve the outcomes of hepatocellular carcinoma (HCC), which has poor prognosis. Methods:We identified 1036 stage I or II HCC patients, diagnosed between 2007-2009, through the linked Surveillance, Epidemiology, and End Results (SEER) Program and Medicare claims database. Of these, 363 patients were using statin either at the time of their HCC diagnosis or afterwards. We conducted multivariable Cox regression analysis to estimate the time-dependent effect of statin on survival. The analysis included age, sex, resection, trans-arterial chemoembolization, transplantation, cirrhosis, cardiovascular disease, diabetes, dyslipidemia, hepatitis B and C. Results: Over a median follow-up time of 21 months, 584 HCC patients died. Statin users had a longer median survival compared to non-users: 23.9 vs. 18.9 months (p = 0.047). However, after accounting for immortal time bias and confounding, statin use was not associated with survival: hazard ratio = 0.98, 95% confidence interval (0.80, 1.20) The associations did not vary by hepatitis C, or intensity of statin use. Conclusions: Statin treatment after HCC diagnosis was not associated with survival in elderly patients with stage I/II disease. Impact: Our study of nationally representative elderly patients with stage I or II HCC in the U.S. shows that statin treatment does not improve survival with liver cancer.