Statin Use and Long-Term Mortality after Rectal Cancer Surgery.

Arvid Pourlotfi,Gabriel Sjolin,Maximilian Peter Forssten,Gary Alan Bass,Rebecka Ahl Hulme,Yang Cao,Shahin Mohseni,Peter Matthiessen

doi:10.3390/cancers13174288

Abstract

Simple SummaryA diagnosis of locally advanced rectal cancer and succeeding surgery remains an area of high postoperative risk for adverse outcomes. The current investigation aims to clarify uncertainty regarding the impact of ongoing statin therapy on postoperative long-term mortality rates after curative surgical resections of rectal cancer by examining data from a large validated national register. It is the first to date to investigate the impact of statin therapy on long-term mortality following curative rectal cancer surgery. Having an ongoing statin prescription was associated with a lower risk of mortality up to five years after surgery. The results should be confirmed in future large, randomized clinical trials.Background: The current study aimed to assess the association between regular statin therapy and postoperative long-term all-cause and cancer-specific mortality following curative surgery for rectal cancer. The hypothesis was that statin exposure would be associated with better survival. Methods: Patients with stage I–III rectal cancer undergoing surgical resection with curative intent were extracted from the nationwide, prospectively collected, Swedish Colorectal Cancer Register (SCRCR) for the period from January 2007 and October 2016. Patients were defined as having ongoing statin therapy if they had filled a statin prescription within 12 months before and after surgery. Cox proportional hazards models were employed to investigate the association between statin use and postoperative five-year all-cause and cancer-specific mortality. Results: The cohort consisted of 10,743 patients who underwent a surgical resection with curative intent for rectal cancer. Twenty-six percent (n = 2797) were classified as having ongoing statin therapy. Statin users had a considerably decreased risk of all-cause (adjusted hazard ratio (HR) 0.66, 95% confidence interval (CI): 0.60–0.73, p < 0.001) and cancer-specific (adjusted HR 0.60, 95% CI: 0.47–0.75, p < 0.001) mortality up to five years following surgery. Conclusions: Statin use was associated with a lower risk of both all-cause and rectal cancer-specific mortality following curative surgical resections for rectal cancer. The findings should be confirmed in future prospective clinical trials.

Highlights

Rectal cancer remains one of the most common malignancies worldwide [1]
The study cohort consisted of 10,743 patients who underwent surgical resection with curative intent for rectal cancer
Twenty-six % (n = 2797) of them were classified as having ongoing statin therapy

Summary

Introduction

Rectal cancer remains one of the most common malignancies worldwide [1]. Treatment of rectal cancer often includes different neoadjuvant treatment modalities, but resection surgery remains the cornerstone of curative treatment. Statins (3-hydroxy-3-methyl-glutaryl-coenzyme A (HMG-CoA) reductase inhibitors) may improve postoperative survival through mechanisms other than their widely recognized lipid-lowering actions [8]. These so-called pleiotropic effects include the reduction of inflammatory responses, as well as direct cardiovascular protection that involves improvement of endothelial function and prevention of thrombotic events [9]. Statin treatment may be advantageous to patients undergoing colorectal cancer surgery in both the immediate and long-term postoperative period. The current study aimed to assess the association between regular statin therapy and postoperative long-term all-cause and cancer-specific mortality following curative surgery for rectal cancer. Results: The cohort consisted of 10,743 patients who underwent a surgical resection with curative intent for rectal cancer

Methods

Results

Conclusion