Statin use and prognosis of lung cancer: a systematic review and meta-analysis of observational studies and randomized controlled trials

Abstract

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

Supplementary materials

Figure S1 Methodological quality of included randomized controlled trials.

Figure S2 Forest plot: overall meta-analysis of all-cause mortality between statin use and lung cancer with or without comorbidities.

Abbreviation: CAD, coronary artery disease.

Figure S3 Forest plot: overall meta-analysis of overall response rate between statin use and lung cancer.

Abbreviations: NSCLC, non-small-cell lung cancer; SCLC, small cell lung cancer.

Table S1 Methodological quality of cohort study and case-control study using the Newcastle–Ottawa scale

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Acknowledgments

Dao-Kui Xia, Zhi-Gang Hu, and Yu-Feng Tian are co-first authors for this study.

Disclosure

The authors report no conflicts of interests in this work.