Aspirin, statins and pancreatic cancer: Is there room for a chemopreventive effect?

Abstract

Introduction: Pancreatic ductal adenocarcinoma (PDAC) has increasing incidence and poor prognosis. Prevention can be a cornerstone in the fight against this deathly cancer. In this context, chemopreventive action of aspirin and statins might prove interesting. However, published data are conflicting, with effect sometimes limited to subgroups, and the possible combined effect of the two drugs has never been explored. Aims: To investigate the possible protective role of aspirin and statin use and their combination on PDAC occurrence. Patients & methods: Case-control study; risk factors were screened through questionnaires about environmental factors, family and medical history. Cases were matched to controls for age and gender. Results: 338 PDAC patients and 663 matched controls (54% males, mean age 68 in both groups) were enrolled. Aspirin (18.6% vs 21.9%) and statin (18.9% vs 23.1%) use was similar in both groups. Neither >5-year aspirin (6.9% vs 7.9%) or statins use (4.5% vs 7%), nor their combination (9.7% vs 9.5%) were different among cases and controls. Aspirin and statin use showed no association with PDAC also in subgroup analyses for men and smokers. In logistic regression multivariate analysis heavy smoking (OR:2.88, CI95%:1.98-4.19), heavy drinking (OR:2.47, CI95%:1.47-4.16), previous diabetes (OR:1.78, CI95%:1.00-3.14), chronic pancreatitis (OR:19.7, CI95%:2.09-185.32), obesity (OR:1.67, CI95%:1.05-2.65) and PDAC family history (OR:2.6, CI95%:1.28-5.31) were all significant risk factors. Conclusion: A chemopreventive effect for aspirin and statin use, or their combination was not observed in our study, nor for prolonged use or subgroup analysis. In our cohort, drugs use was mostly daily-dose for cardiovascular event prevention and higher doses might be needed. Known risk factors for PDAC were confirmed.