In the Journals

Statin use linked to reduced mortality after esophageal cancer diagnosis

Use of statins after a diagnosis of esophageal adenocarcinoma was found to be associated with reduced esophageal cancer-specific and all-cause mortality, according to the results of a large population-based cohort study.

However, researchers did not observe this association in patients with esophageal squamous cell carcinoma.

“A population-based cohort study in Denmark showed that statin use before a diagnosis of [esophageal cancer] was associated with a 19% decrease in cancer-specific mortality,” the researchers wrote. “Whether statin use after a diagnosis of [esophageal cancer], a more relevant time period for clinical intervention, improves survival is unknown. Furthermore, whether or not statins exert differential effects on survival for the two main histologic subtypes, [esophageal adenocarcinoma] and [esophageal squamous cell carcinoma], is unknown.”

The researchers therefore used linked national databases to identify 4,445 patients diagnosed with esophageal or esophagogastric junction cancers from January 2000 through November 2009, and followed up until November 2011 in the U.K. Subsets of patients had data available on histologic subtype (n = 1,165) and cancer-specific mortality (n = 1,530). Using Cox proportional hazard regression analysis with time-dependent exposures, they estimated associations between use of simvastatin, atorvastatin, pravastatin, rosuvastatin and fluvastatin after diagnosis, and esophageal cancer-specific and all-cause mortality.

Median survival time was 9.2 months (interquartile range, 3.7-23.2 months) for the whole cohort, 18.7% of whom used statins after their diagnosis. Accounting for immortal time bias, the median survival time was 14.9 months (IQR, 7.1-52.3 months) among patients who used statins after cancer diagnosis, and 8.1 months (IQR, 3.3-20 months) for those who did not use statins.

Postdiagnostic statin use was associated with an overall reduced risk of esophageal cancer-specific mortality (adjusted HR = 0.62; 95% CI, 0.44-0.86) and all-cause mortality (HR = 0.67; 95% CI, 0.58-0.77). Analysis of only patients with esophageal adenocarcinoma showed an association between postdiagnostic statin use and a reduced risk for esophageal cancer-specific mortality (HR = 0.61; 95% CI, 0.38-0.96) and all-cause mortality (HR = 0.63; 95% CI, 0.43-0.92), but this association was not observed in patients with esophageal squamous cell carcinoma.

The researchers did not observe any significant interactions between prior statin use and these associations. However, they observed significant dose and cumulative dose-response associations for prediagnosis statin use and all-cause mortality.

They also found that use of simvastatin and atorvastatin, but not the other statins analyzed, was associated with reduced esophageal cancer-specific mortality, while all of the statins analyzed were associated with reduced all-cause mortality.

“This large population-based cohort study of patients with incident [esophageal cancer] found that postdiagnosis statin use was associated with a 39% reduction in [esophageal cancer]-specific mortality and a 33% reduction in all-cause mortality,” the researchers concluded. “In patients with esophageal adenocarcinoma specifically, postdiagnosis statin use was associated with a 39% reduction in [esophageal cancer]-specific mortality and a 37% reduction in all-cause mortality. There were no significant improvements in survival associated with postdiagnosis statin use for [esophageal squamous cell carcinoma] or [esophagogastric junctional adenocarcinoma].” – by Adam Leitenberger

Disclosure: The researchers report no relevant financial disclosures.

Use of statins after a diagnosis of esophageal adenocarcinoma was found to be associated with reduced esophageal cancer-specific and all-cause mortality, according to the results of a large population-based cohort study.

However, researchers did not observe this association in patients with esophageal squamous cell carcinoma.

“A population-based cohort study in Denmark showed that statin use before a diagnosis of [esophageal cancer] was associated with a 19% decrease in cancer-specific mortality,” the researchers wrote. “Whether statin use after a diagnosis of [esophageal cancer], a more relevant time period for clinical intervention, improves survival is unknown. Furthermore, whether or not statins exert differential effects on survival for the two main histologic subtypes, [esophageal adenocarcinoma] and [esophageal squamous cell carcinoma], is unknown.”

The researchers therefore used linked national databases to identify 4,445 patients diagnosed with esophageal or esophagogastric junction cancers from January 2000 through November 2009, and followed up until November 2011 in the U.K. Subsets of patients had data available on histologic subtype (n = 1,165) and cancer-specific mortality (n = 1,530). Using Cox proportional hazard regression analysis with time-dependent exposures, they estimated associations between use of simvastatin, atorvastatin, pravastatin, rosuvastatin and fluvastatin after diagnosis, and esophageal cancer-specific and all-cause mortality.

Median survival time was 9.2 months (interquartile range, 3.7-23.2 months) for the whole cohort, 18.7% of whom used statins after their diagnosis. Accounting for immortal time bias, the median survival time was 14.9 months (IQR, 7.1-52.3 months) among patients who used statins after cancer diagnosis, and 8.1 months (IQR, 3.3-20 months) for those who did not use statins.

Postdiagnostic statin use was associated with an overall reduced risk of esophageal cancer-specific mortality (adjusted HR = 0.62; 95% CI, 0.44-0.86) and all-cause mortality (HR = 0.67; 95% CI, 0.58-0.77). Analysis of only patients with esophageal adenocarcinoma showed an association between postdiagnostic statin use and a reduced risk for esophageal cancer-specific mortality (HR = 0.61; 95% CI, 0.38-0.96) and all-cause mortality (HR = 0.63; 95% CI, 0.43-0.92), but this association was not observed in patients with esophageal squamous cell carcinoma.

The researchers did not observe any significant interactions between prior statin use and these associations. However, they observed significant dose and cumulative dose-response associations for prediagnosis statin use and all-cause mortality.

They also found that use of simvastatin and atorvastatin, but not the other statins analyzed, was associated with reduced esophageal cancer-specific mortality, while all of the statins analyzed were associated with reduced all-cause mortality.

“This large population-based cohort study of patients with incident [esophageal cancer] found that postdiagnosis statin use was associated with a 39% reduction in [esophageal cancer]-specific mortality and a 33% reduction in all-cause mortality,” the researchers concluded. “In patients with esophageal adenocarcinoma specifically, postdiagnosis statin use was associated with a 39% reduction in [esophageal cancer]-specific mortality and a 37% reduction in all-cause mortality. There were no significant improvements in survival associated with postdiagnosis statin use for [esophageal squamous cell carcinoma] or [esophagogastric junctional adenocarcinoma].” – by Adam Leitenberger

Disclosure: The researchers report no relevant financial disclosures.