Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA; Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas, USA. Electronic address: firstname.lastname@example.org.
Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA; Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.
Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
BACKGROUND & AIMS:
Statin use is associated with lower risk of developing hepatocellular carcinoma (HCC). However, it is unclear whether post-diagnosis statin use is associated with reduced risk of mortality in HCC patients.
We used data from 15,422 patients with HCC in the VA Central Cancer Registry diagnosed between 2002 and 2016. We identified statin prescriptions that were filled before and after cancer diagnosis, and used time-dependent Cox regression models to calculate adjusted hazard ratios (HR) and 95% CIs for mortality risk. We used a time-varying exposure to avoid immortal-time bias, and a 3 month lag (following patients from 3 months after cancer diagnosis) to reduce reverse causation. A sensitivity analysis was conducted varying the lag duration between date of cancer diagnosis and start of follow-up.
Statin use after diagnosis was recorded in 14.9% of HCC patients. We found that post-diagnosis statin use was associated with a decreased risk of cancer specific (adjusted HR, 0.85; 95% CI, 0.77-0.93) and all-cause mortality (HR, 0.89; 95% CI, 0.83-0.95). The magnitudes of these inverse associations were consistent for HCC patients using both low- and high-dose statins, and the inverse associations remained across a range of lag periods (from 0 months to 12 months after HCC diagnosis). We found no evidence for effect modification by pre-diagnosis statin use, or by presentation or treatment-related factors, and no independent association with pre-diagnosis statin use.
Post-diagnosis statin use was associated with reduced mortality in HCC patients.