Statins have been implicated in the regulation of cell proliferation, apoptosis, and tumour progression in patients with malignancy and thereby reduce cancer risk and improve survival. We therefore aimed to establish the association between statin use and cancer survival by a systematic review and meta-analysis of published studies.
A systematic literature search of Pubmed, Embase, CENTRAL and American Society of Clinical Oncology (ASCO) databases through May 2015 was conducted to identify studies assessing the prognostic impact of statin use on survival outcomes in patients diagnosed with cancer. The hazard ratio (HR) and 95% confidence interval (CI) were derived and pooled using the random-effects Mantel-Haenszel model.
After screening 5622 citations identified in the original search, we identified 92 cohorts covering over 18 cancer types totaling 703843 patients who met the inclusion criteria. A meta-analysis of 55 articles showed that statin use was significantly associated with a decreased all-cause mortality (HR 0.70, 95% Cl 0.66 to 0.74) compared with non-users. Subgroup analyses according to initiation of statins showed postdiagnosis statin users (HR 0.65, 95% Cl 0.54 to 0.79) gained significantly more recurrence-free survival benefit than prediagnosis statin users (HR 0.86, 95% Cl 0.77 to 0.96) (P for interaction = 0.018). The observed pooled estimates were retained for cancer-specific mortality (HR 0.59, 95% Cl 0.45 to 0.77), progression-free mortality (HR 0.67, 95% Cl 0.56 to 0.81), recurrence-free mortality (HR 0.74, 95% Cl 0.65 to 0.83) and disease-free mortality (HR 0.53, 95% Cl 0.40 to 0.72). These associations almost remained consistent across those outcomes when stratified by publication type, tumour location, study design, sample size, initiation of statins, disease stage, research country, follow-up duration or research hospital involved.
Statin therapy has potential survival benefit for patients with malignancy. Further large-scale prospective studies emphasising survival outcomes of individual cancer type are strongly encouraged.
Clinical trial identification
All authors have declared no conflicts of interest.