Impact of Statin Use on Oncological Outcomes of Patients with Urothelial Carcinoma of the Bladder Treated With Radical Cystectomy
da Silva RD, Xylinas E, Kluth L, Crivelli JJ, Chrystal J, Chade D, Guglielmetti GB, Pycha A, Lotan Y, Karakiewicz PI, Sun M, Fajkovic H, Zerbib M, Scherr DS, Shariat SF. J Urol. 2013 Feb 7. pii: S0022-5347(13)00268-1. doi: 10.1016/j.juro.2013.02.003. [Epub ahead of print]

Source

Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA; Department of Urology Cancer Institute of Sao Paulo (ICESP), University of Sao Paulo, Brazil.

Abstract

PURPOSE:

Statins are cholesterol-lowering agents used to prevent cardiovascular disease. Evidence suggests a dichotomous effect of statins with both cancer-inhibiting and -promoting properties. To date, the effect of statin use on prognosis in muscle-invasive urothelial carcinoma of the bladder (UCB) remains uninvestigated. We tested the hypothesis that statin use impacts oncologic outcomes of patients treated with radical cystectomy (RC) for UCB.

MATERIALS AND METHODS:

We retrospectively evaluated 1502 patients treated at four institutions with RC and pelvic lymphadenectomy without neoadjuvant therapy. Cox regression models addressed the association of statin use with disease recurrence and cancer-specific mortality.

RESULTS:

A total of 642 (42.7%) patients used statins. Within a median follow-up of 34 months, 509 (33.9%) patients experienced disease recurrence and 402 patients (26.8%) died of UCB. Statin users were older (p=0.003), had a higher BMI (median 32 vs 28Kg/m(2),p<0.001), and were more likely to have positive soft tissue surgical margins (9 vs 4%,p<0.001). In univariable Cox regression analyses, statin use, female gender, advanced age, higher BMI, smoking status, tumor stage, tumor grade, soft tissue surgical margin status, lymphovascular invasion, lymph node metastasis, and adjuvant chemotherapy were all associated with both disease recurrence (p-values=0.05) and cancer-specific mortality (p-values=0.02). In multivariable Cox regression analyses, statin use was not associated with both outcomes.

CONCLUSIONS:

Statin users were at higher risk of disease recurrence and cancer-specific mortality in univariable but not in multivariable analyses. These data do not support modifications of statin use in patients with high-risk UCB who are to be treated with RC.