Statins associated with reduced mortality risk in hepatocellular carcinoma

Patients with hepatocellular carcinoma (HCC) who take statins after diagnosis may have a lower risk for death, a recent study found.

Researchers used data from the Veterans Affairs (VA) Central Cancer Registry to perform a retrospective cohort study examining the potential effects of statins on cancer-specific and all-cause mortality in patients diagnosed with HCC between 2002 and 2016. They identified statin prescriptions filled before and after cancer diagnosis and calculated adjusted hazard ratios for mortality risk. Patients were followed until date of death or Dec. 31, 2016, whichever was sooner. The study results were published Jan. 6 by Clinical Gastroenterology and Hepatology.

Overall, 15,422 patients with HCC were included in the study. During 28,680 person-years of follow-up, 78.8% died, and the median survival time was 17.24 months. After HCC diagnosis, 2,293 (14.9%) patients used statins, and 857 (5.6%) used them exclusively after diagnosis and not before. Patients who used statins after their HCC diagnosis were more likely to be older and to have higher body mass index at cancer diagnosis, but their liver disease at diagnosis was less severe. Median survival time after HCC diagnosis was 26.38 months in those who used statins postdiagnosis and 15.67 months in those who did not.

Postdiagnosis statin use was associated with lower risk for cancer-specific death (adjusted hazard ratio, 0.85; 95% CI, 0.77 to 0.93) and all-cause mortality (adjusted hazard ratio, 0.89; 95% CI, 0.83 to 0.95). These inverse associations were consistent for low- and high-dose statins and for a range of time periods after HCC diagnosis (0 months to 12 months). Prediagnosis statin use, patient presentation, and treatment-related factors did not seem to affect these associations, and no independent association was seen with prediagnosis statin use.

The authors noted that their study could have missed statins dispensed at non-VA pharmacies and may have been underpowered to detect an association between statin use only after diagnosis and mortality risk, given that only 5.6% of patients used statins after HCC diagnosis but not before. In addition, they pointed out that their study included only veterans with HCC and that the results may therefore not be generalizable. However, despite these and other limitations, the authors concluded that there is a “strong and statistically significant inverse association” between use of statins after HCC diagnosis and risk for death. The authors noted that their findings are biologically plausible, “since statins inhibit not only cholesterol synthesis but also reduce other important downstream products, including membrane integrity maintenance, cell signaling, protein synthesis, and cell-cycle progression.” They called for future studies to specifically examine these and related mechanisms of action.