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2015 ; 94
(42
): e1801
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Statin-Based Palliative Therapy for Hepatocellular Carcinoma
#MMPMID26496314
Shao JY
; Lee FP
; Chang CL
; Wu SY
Medicine (Baltimore)
2015[Oct]; 94
(42
): e1801
PMID26496314
show ga
Most hepatocellular carcinoma (HCC) patients worldwide do not receive curative
treatments. Alternative treatments for most HCC patients include palliative
treatments, such as transarterial chemoembolization (TACE), chemotherapy, and
radiotherapy. Although statins may be a chemopreventive treatment option for
reducing hepatitis B virus (HBV)- and hepatitis C virus (HCV)-related HCC risks,
their therapeutic effects are unknown. This study evaluated the effects of statin
on HCC patients receiving palliative treatment.Data from the National Health
Insurance claims database and cancer registry databases of The Collaboration
Center of Health Information Application, Taiwan, were analyzed. We included HCC
patients who were treated between January 1, 2001, and December 31, 2010, and
followed them from the index date to December 31, 2012. The inclusion criteria
were presence of HBV carrier-related HCC, age >20 years, and having received
TACE, radiotherapy, or chemotherapy as palliative treatment. The exclusion
criteria were cancer diagnosis before HCC was confirmed, surgery, liver
transplantation, radiofrequency ablation, or percutaneous ethanol injection as
curative treatment, missing sex-related information, HCC diagnosis before HBV,
and age <20 years. We enrolled 20,200 HCC patients.The median follow-up duration
was 1.66 years (interquartile range, 0.81). In total, 1988 and 18,212 patients
received palliative treatment with and without statin use, respectively. HCC
patients who received palliative treatment with statin use had lower HCC-specific
deaths in all stages than those who received palliative treatment without statin
use (P = 0.0001, 0.0002, 0.0012, and 0.0002, and relative risk (RR) = 0.763,
0.775, 0.839, and 0.718, for stages I-IV, respectively). In all-cause and
HCC-specific deaths, decreasing trends (P for trend <0.0001) of adjusted hazard
ratios (aHRs) were observed in all stages with no treatment, statin use only,
palliative treatment only, and palliative treatment plus statin use. The aHRs of
all-cause and HCC-specific deaths increased with the progress in cancer stage and
reduced with the use of advanced therapeutic modalities (P for trend <0.0001).
Differences in HBV- and non-HBV-related HCC were solely due to statin use. Statin
use alone reduced HCC-specific deaths by 36% in non-HBV-related HCC in stage I
and 50% in HBV-related HCC in stages II and III. With a relatively substantial
reduction in mortality, the therapeutic effects of statin use were stronger in
HBV-related HCC than in non-HBV-related HCC.Palliative treatments are critical
for HCC patients. Multiple therapeutic methods with statin use reduced the
mortality risk. Statins prolong the survival of patients with advanced HCC
receiving palliative treatment, thus demonstrating its therapeutic value as an
adjuvant treatment. Furthermore, statin-based palliative treatment in early stage
HCC remarkably reduced the number of deaths. For patients who cannot tolerate
palliative treatments, statin use only might possibly reduce mortality,
particularly in HBV-related early stage HCC patients (>50% reduction in HCC
deaths).
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