Statin use and prognosis of lung cancer: a systematic review and meta-analysis of observational studies and randomized controlled trials
Authors Xia DK, Hu ZG, Tian YF, Zeng FJ
Received 15 September 2018
Accepted for publication 20 December 2018
Published 23 January 2019 Volume 2019:13 Pages 405—422
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Professor Manfred Ogris
Dao-Kui Xia,1,* Zhi-Gang Hu,2,3,* Yu-Feng Tian,4,* Fan-Jun Zeng2,3
1Department of Thoracic Surgery, Yichang Central People’s Hospital, Yichang, PR China; 2Department of Respiratory Medicine, Respiratory Disease Research Institute of China, Three Gorges University, Yichang, PR China; 3Department of Respiratory Medicine, Yichang Central People’s Hospital, Yichang, PR China; 4Department of Academic Management, Clinical Research Center, Three Gorges University, Yichang, PR China
*These authors contributed equally to this work
Background: Previous clinical studies reported inconsistent results on the associations of statins with the mortality and survival of lung cancer patients. This review and meta-analysis summarized the impact of statins on mortality and survival of lung cancer patients.
Materials and methods: Eligible papers of this meta-analysis were searched by using PubMed, EMBASE, and Cochrane until July 2017. Primary end points were the mortality (all-cause mortality and cancer-specific mortality) and survival (progression-free survival and overall survival) of patients with statin use. Secondary end points were overall response rate and safety. The random-effects model was used to calculate pooled HRs and 95% CIs.
Results: Seventeen studies involving 98,445 patients were included in the meta-analysis. In observational studies, the pooled HR indicated that statins potentially decreased the cancer-specific mortality and promoted the overall survival of lung cancer patients. Statins showed an association with decreased all-cause mortality in cohort studies (HR =0.77, 95% CI: 0.59–0.99), but not in case-control studies (HR =0.75, 95% CI: 0.50–1.10). However, statin use showed no impact on mortality and overall survival in randomized controlled trials. Meanwhile, this meta-analysis indicated that statin use did not affect the progression-free survival of lung cancer patients in observational studies and randomized controlled trials. In addition, statins potentially enhanced the effects of tyrosine kinase inhibitors (HR=0.86, 95% CI: 0.76–0.98) and chemotherapy (HR=0.86, 95% CI: 0.81–0.91) on the overall survival of patients with non-small-cell lung cancer, but did not increase overall response rate and toxicity.
Conclusion: Statins were potentially associated with the decreasing risk of mortality and the improvement of overall survival in observational studies but not in randomized controlled trials.
Keywords: statin, lung cancer, mortality, survival, statins, lung cancer, prognosis
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