Statin Use Not Associated With Reduced Mortality in Patients With Colorectal Cancer


Key Points

  • At a median follow-up time of 3.4 years, use of statins by patients with colorectal cancer was not associated with reduced overall, colorectal cancer–specific, or recurrence-free survival.
  • Patients with stage I and II disease who used statins had better recurrence-free survival but not better colorectal cancer–specific survival.
  • No reduction in mortality for statin users was observed after stratifying for major pathologic subgroups.

Statin use was not associated with reduced mortality among patients diagnosed with primary colorectal cancer between 2003 and 2009 and followed for a median of 3.4 years in the Darmkrebs: Chancen der Verhütung durch Screening (DACHS) study, an ongoing population-based study of colorectal cancer in southwest Germany.

Writing in the Journal of the National Cancer Institute, Hoffmeister et al acknowledged that statins had been associated with moderate reductions in mortality among patients with colorectal cancer in previous studies but noted that “these studies lacked adjustment for some potentially relevant factors associated with statin use.” The reported effects of statins in these previous studies “might reflect incomplete control for stage at diagnosis and other factors associated with the use of statins.”

More Likely to Have Stage I or II Disease

In the current study, “the use of statins and other risk or protective factors were assessed in standardized interviews with 2,697 patients,” the researchers reported. The average age of the patients was 68 years, 40% were women, and 412 patients (15%) had used statins.

The use of statins was associated with being older, male, having a higher body mass index (BMI), a greater number of pack years of smoking, more frequent use of nonsteroidal anti-inflammatory drugs (NSAIDs), and a lower cancer stage. Among the 412 statin users, 59% had stage I or stage II disease, compared with 51% of the 2,285 patients who had not used statins. Along with higher rates of hypercholesterolemia (88% for statin users vs 21% for nonusers), statin users were more likely to have a history of diabetes, myocardial infarction, stroke, and heart failure and to have general health checkups.

“Follow-up included assessment of therapy details, recurrence, vital status, and cause of death. Information about molecular pathological subtypes of [colorectal cancer] was available for 1,209 patients,” the authors added. A total of 769 patients (29%) died during follow-up.

No Associations for Pathologic Subtypes

At a median follow-up of 3.4 years, statin use was not associated with overall (hazard ratio [HR] = 1.10, 95% confidence interval [CI] = 0.85–1.41), colorectal cancer–specific (HR = 1.11, 95% CI = 0.82–1.50), or recurrence-free survival (HR = 0.90, 95% CI = 0.63–1.27), the authors reported. Patients with stage I and II disease who used statins had better recurrence-free survival but not better colorectal cancer–specific survival.

“Subgroup analyses according to duration of use, active ingredient, and by age, sex, [colorectal cancer] stage and location, and by conduct of chemotherapy also suggested no improvement of overall or [colorectal cancer–]specific survival with the use of statins,” the authors continued. “Furthermore, analyses by the more common forms of major molecular pathologic subtypes of [colorectal cancer] ([microsatellite instability], CIMP, KRAS, and [estrogen receptor–beta] expression) did not indicate an association of statin use with improved survival.” The researchers noted that to their knowledge, “the present study is the first to report associations of statin use and survival by pathological subtype in an unselected cohort of [colorectal cancer] patients.”

Michael Hoffmeister, PhD, of the German Cancer Research Center in Heidelberg, is the corresponding author of the Journal of the National Cancer Institute.

The study was supported by the German Research Council, the German Federal Ministry of Education and Research, and the Interdisciplinary Research Program of the National Center for Tumor Diseases.

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