降脂药与三阴性乳腺癌患者生存结局
他汀类是重要的降胆固醇药物，还被证明可靶向乳腺癌致癌作用相关通路，尤其对于三阴性乳腺癌。不过，既往分析他汀类药物治疗对乳腺癌结局影响的小样本研究结果不一。
2021年8月3日，美国癌症学会《癌症》在线发表贝勒医学院、德克萨斯大学MD安德森癌症中心、布法罗大学的大样本研究报告，分析了乳腺癌确诊后开始他汀类药物治疗对患者生存结局的影响。
该研究利用2008～2015年美国国家癌症研究所（NCI）监测流行病学最终结果（SEER）数据库和德克萨斯癌症登记数据库与联邦医疗保险数据库的关联数据，对早期（I、II、III期）乳腺癌确诊前12个月内未用过他汀类药物治疗的2万3192例年龄≥66岁女性进行分析。利用多因素比例风险回归模型，对乳腺癌确诊后12个月内开始用他汀类药物治疗对患者总生存和乳腺癌相关生存的影响。此外，利用竞争风险模型，对其他原因所致死亡风险进行校正。
结果，对于其中1534例三阴性乳腺癌患者，乳腺癌确诊后12个月内用与未用他汀类药物治疗相比：
乳腺癌相关死亡风险低58%（校正风险比：0.42，95%置信区间：0.20～0.88，P=0.022）
任何原因致死亡风险低30%（校正风险比：0.70，95%置信区间：0.50～0.99，P=0.046）
对于其余15979例非三阴性乳腺癌患者，乳腺癌确诊后12个月内用与未用他汀类药物治疗相比：
乳腺癌相关死亡风险相似（校正风险比：0.99，95%置信区间：0.71～1.39，P=0.97）
任何原因致死亡风险相似（校正风险比：1.04，95%置信区间：0.92～1.17，P=0.55）
对他汀类用药时间进行分析时，上述结果基本不变。
因此，该大数据回顾分析结果表明，对于早期三阴性乳腺癌老年女性，乳腺癌确诊后12个月内开始用他汀类药物治疗，总生存和乳腺癌相关生存获益较大。他汀类药物可能对特定乳腺癌患者发挥作用，故有必要进一步开展前瞻干预研究进行验证。
相关链接
Cancer. 2021 Aug 3. Online ahead of print.
Association of statin use with clinical outcomes in patients with triple-negative breast cancer.
Nowakowska MK, Lei X, Thompson MT, Shaitelman SF, Wehner MR, Woodward WA, Giordano SH, Nead KT.
Baylor College of Medicine, Houston, Texas; The University of Texas MD Anderson Cancer Center, Houston, Texas; University at Buffalo, Buffalo, New York.
Statins have been shown to target pathways related to breast cancer carcinogenesis, particularly in aggressive subtypes like triple-negative breast cancer. A statistically significant association is reported between clinical outcomes and incident statin use in patients with triple-negative breast cancer in a large sample of patients from the Surveillance, Epidemiology, and End Results-Medicare database.
BACKGROUND: Previous studies have examined the association of statin therapy and breast cancer outcomes with mixed results. The objective of this study was to investigate the clinical effects of incident statin use among individuals with triple-negative breast cancer (TNBC).
METHODS: Data from the Surveillance, Epidemiology, and End Results-Medicare and Texas Cancer Registry-Medicare databases were used, and women aged ≥66 years who had stage I, II, and III breast cancer were identified. Multivariable Cox proportional hazards regression models were used to examine the association of new statin use in the 12 months after a breast cancer diagnosis with overall survival (OS) and breast cancer-specific survival (BCSS).
RESULTS: When examining incident statin use, defined as the initiation of statin therapy in the 12 months after breast cancer diagnosis, a significant association was observed between statin use and improved BCSS (standardized hazard ratio, 0.42; 95% confidence interval [CI], 0.20-0.88; P = .022) and OS (hazard ratio, 0.70; 95% CI, 0.50-0.99; P = .046) among patients with TNBC (n = 1534). No association was observed with BCSS (standardized hazard ratio, 0.99; 95% CI, 0.71-1.39; P = .97) or OS (hazard ratio, 1.04; 95% CI, 0.92-1.17; P = .55) among those without TNBC (n = 15,979). The results were consistent when examining statin exposure as a time-varying variable.
CONCLUSIONS: Among women with I, II, and III TNBC, initiation of statin therapy in the 12 months after breast cancer diagnosis was associated with an OS and BCSS benefit. Statins may have a role in select patients with breast cancer, and further investigation is warranted.
KEYWORDS: Surveillance, Epidemiology, and End Results-Medicare; and End Results-Medicare; breast cancer; statins; triple-negative breast cancer
PMID: 34342892
DOI: 10.1002/cncr.33797