他汀类药物可降低肝癌死亡风险

StephenW

Statins May Lower Death Risk in Liver Cancer                                                                By Cole  Petrochko, Staff Writer, MedPage TodayPublished: January 27, 2013
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco
Action Points                                                

• This study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
• Statin use seemed to reduce the risk of death in patients with hepatocellular cancer.
• Point out that the positive effect of statin use on overall survival remained significant even after adjusting for age, sex, race, staging, hepatitis C and B history, liver cirrhosis, treatment, alcohol use, and diabetes.
  

SAN FRANCISCO  --  Statin use seemed to reduce the risk of death in patients with hepatocellular cancer, researchers reported here.
In a cohort of patients with hepatocellular carcinoma (HCC), those who used statins in addition to local and systemic therapy or surgical resection had a 30% reduction in mortality versus those who did not use statins (hazard ratio 0.7, 95% CI 0.5 to 0.9), according to Young Kwang Chae, MD, of the University of Texas MD Anderson Cancer Center in Houston, and colleagues.
The positive effect on overall survival (OS) remained significant even after adjusting for age, sex, race, staging, hepatitis C and B history, liver cirrhosis, treatment, alcohol use, and diabetes (aHR 0.7, 95% CI 0.5 to 0.9, P=0.03), Chae said at a poster session during the Gastrointestinal Cancers Symposium.
The authors noted that "preclinical evidence supports antitumoral activity of statins," adding that several observational studies showed a protective effect of statin use with incidence of hepatocellular cancer.
"Hepatocellular cancer is a very vascular disease," Chae told MedPage Today.
The investigators followed 644 patients with pathologically confirmed HCC patients over 10 years. The sample included 68 statin users and 571 non-users who were mostly white (69.1% and 65%, respectively) and male (77.9% and 72.9% respectively). The median OS of all patients was 19.2 months, and 10.7% reported statin use.
More than half (70.7%) were diagnosed at TNM stage III and IV, while 52.6% had no evidence of hepatitis B or C virus infection. Local and systemic therapy was done in 81.7% of the patients while 18.3% underwent surgical resection.
Median OS was higher among statin users than non-users at 25.4 months versus 18.5 months (P=0.04).
Among patients without cirrhosis, statin use was associated with a 40% mortality reduction (HR 0.6, 95% CI 0.4 to 0.9, P=0.04).
History of hepatitis did not affect outcomes, nor did age, sex, race, staging, treatment type, alcohol use, or diabetes status.
Chae noted that HCC patients taking statins were older (mean age 63.1) and many had diabetes (51.5%). These participants had "more cardiovascular disease and were more likely to be sick and have poor prognosis, but, in fact, they actually lived longer," Chae pointed out.
Chae said that potential areas for follow-up would be tests to determine subgroups  --  such as cirrhosis versus non-cirrhosis patients  --  where statin use is most effective. "There should be a group that statins are most effective in, and I would like to randomize them to use," he said.
The authors also noted the study could be validated with a large, prospective study.
The study was limited by retrospective data and lack of randomization among patients, although Chae noted that the latter was offset in the multivariate analysis.
The authors had no conflicts of interest.

Primary source: Gastrointestinal Cancers Symposium
Source reference:
Chae YK, et al "The association between statin use and hepatocellular cancer outcome" GiCS 2013; Abstract 165.

                                                                                                                                                                                       

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StephenW

要点

    这项研究结果发表作为一个抽象的，在一次会议上。这些数据和结论应被视为是初步的，直到在同行评审期刊发表。
    似乎他汀类药物的使用，以减少肝癌患者的死亡风险。
    指出的是，使用他汀类药物的积极作用，在总生存期显着，即使在调整了年龄，性别，种族，分期，C型肝炎和B的历史，肝硬化，治疗，饮酒，糖尿病。

SAN FRANCISCO  - 似乎他汀类药物的使用，以减少肝癌患者的死亡风险，研究人员在这里。

在队列的患者与肝细胞肝癌（HCC），使用他汀类药物在局部和全身治疗或手术切除的死亡率降低了30％，相对于那些没有使用他汀类药物（危险比为0.7，95％CI 0.5〜 0.9），，根据光蔡杨，医学博士，德克萨斯大学MD安德森癌症中心在休斯敦大学的，和他的同事。

在总生存期（OS）保持积极的作用显着，即使在调整了年龄，性别，种族，分期，C型肝炎和B的历史，肝硬化，治疗，饮酒，糖尿病（AHR 0.7，95％CI为0.5〜0.9 P = 0.03），蔡说，在海报会议在胃肠道癌症研讨会。

作者指出，“临床证据支持他汀类药物的抗肿瘤活性，”一些观察性研究与肝癌的发病率有明显的保护作用的他汀类药物的使用。

“肝癌是一种非常血管疾病，”蔡说MedPage今天。

研究人员追踪644例患者经手术病理证实的肝癌患者超过10年。样本包括68个他汀类药物用户和571用户大多是白色的（，分别为69.1％和65％）和男性（分别为77.9％和72.9％）。所有患者的中位OS为19.2个月，10.7％的他汀类药物的使用。

超过一半（70.7％）被诊断为TNMⅢ，Ⅳ期，而52.6％的人没有乙型或丙型肝炎病毒感染的证据。 18.3％，而81.7％的患者接受手术切除的局部和全身治疗。

中位OS为他汀类药物使用者比非使用者之间的为25.4个月和18.5个月（P = 0.04）。

无肝硬化的患者，他汀类药物的使用，相关的死亡率降低了40％（HR 0.6，95％CI 0.4〜0.9，P = 0.04）。

肝炎病史不影响结果，也没有年龄，性别，种族，分期，治疗类型，饮酒，糖尿病状态。

蔡指出，肝癌患者服用他汀类药物的老年人（平均年龄63.1），许多患有糖尿病（51.5％）。这些参与者有更多的心血管疾病，更容易生病而预后差，但是，事实上，他们活得更长，“蔡指出。

蔡说，后续潜力的地区测试，以确定分组 - 如肝硬化与非肝硬化患者 - 他汀类药物的使用是最有效的。 “应该有一个组，他汀类药物是最有效的，我想随机它们使用，”他说。

作者还指出，这项研究将验证一个大型前瞻性研究。

这项研究是有限的追溯数据和缺乏随机的患者，虽然蔡指出的是，后者是在多变量分析抵销。

有没有利益冲突。

主要来源：胃肠道癌症研讨会
来源参考：
蔡YK等人“之间的关联，他汀类药物的使用和肝癌结果”GICS 2013年，摘要165。