Impact of statin use on oncologic outcomes in patients with urothelial carcinoma of the bladder treated with radical cystectomy

Rodrigo Donalisio Da Silva, Evanguelos Xylinas, Luis Kluth, Joseph J. Crivelli, James Chrystal, Daher Chade, Giuliano Betoni Guglielmetti, Armin Pycha, Yair Lotan, Pierre I. Karakiewicz, Maxine Sun, Harun Fajkovic, Marc Zerbib, Douglas S. Scherr, Shahrokh F. Shariat

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Purpose: Statins are cholesterol lowering agents used to prevent cardiovascular disease. Evidence suggests a dichotomous effect of statins with cancer inhibiting and promoting properties. To our knowledge the effect of statins on the prognosis of muscle invasive urothelial carcinoma of the bladder remains uninvestigated to date. We tested the hypothesis that statin use impacts oncological outcomes in patients treated with radical cystectomy for urothelial carcinoma of the bladder. Materials and Methods: We retrospectively evaluated the records of 1,502 patients treated with radical cystectomy and pelvic lymphadenectomy without neoadjuvant therapy at a total of 4 institutions. Cox regression models were used to determine the association of statins with disease recurrence and cancer specific mortality. Results: A total of 642 patients (42.7%) were on statins. At a median followup of 34 months 509 patients (33.9%) experienced disease recurrence and 402 (26.8%) had died of urothelial carcinoma of the bladder. Statin users were older (p = 0.003), had a higher body mass index (median 32 vs 28 kg/m2, p <0.001) and were more likely to have positive soft tissue surgical margins (9% vs 4%, p <0.001). On univariable Cox regression analysis statins, female gender, advanced age, higher body mass index, smoking status, tumor stage, tumor grade, soft tissue surgical margin status, lymphovascular invasion, lymph node metastasis and adjuvant chemotherapy were associated with disease recurrence (p ≤0.05) and cancer specific mortality (p ≤0.02). On multivariable Cox regression analysis statin use was not associated with either outcome. Conclusions: Statin users were at higher risk for disease recurrence and cancer specific mortality on univariable but not multivariable analysis. These data do not support modification of statin use in patients with high risk urothelial carcinoma of the bladder who will be treated with radical cystectomy.

Original languageEnglish (US)
Pages (from-to)487-492
Number of pages6
JournalJournal of Urology
Volume190
Issue number2
DOIs
StatePublished - Aug 2013

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Cystectomy
Urinary Bladder
Carcinoma
Recurrence
Neoplasms
Mortality
Body Mass Index
Regression Analysis
Neoadjuvant Therapy
Adjuvant Chemotherapy
Lymph Node Excision
Proportional Hazards Models
Cardiovascular Diseases
Lymph Nodes
Smoking
Cholesterol

Keywords

  • hydroxymethylglutaryl-CoA reductase inhibitors
  • mortality
  • neoplasm recurrence
  • urinary bladder
  • urinary bladder neoplasms

ASJC Scopus subject areas

  • Urology

Cite this

Da Silva, R. D., Xylinas, E., Kluth, L., Crivelli, J. J., Chrystal, J., Chade, D., ... Shariat, S. F. (2013). Impact of statin use on oncologic outcomes in patients with urothelial carcinoma of the bladder treated with radical cystectomy. Journal of Urology, 190(2), 487-492. https://doi.org/10.1016/j.juro.2013.02.003

Impact of statin use on oncologic outcomes in patients with urothelial carcinoma of the bladder treated with radical cystectomy. / Da Silva, Rodrigo Donalisio; Xylinas, Evanguelos; Kluth, Luis; Crivelli, Joseph J.; Chrystal, James; Chade, Daher; Guglielmetti, Giuliano Betoni; Pycha, Armin; Lotan, Yair; Karakiewicz, Pierre I.; Sun, Maxine; Fajkovic, Harun; Zerbib, Marc; Scherr, Douglas S.; Shariat, Shahrokh F.

In: Journal of Urology, Vol. 190, No. 2, 08.2013, p. 487-492.

Research output: Contribution to journalArticle

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 2013, 'Impact of statin use on oncologic outcomes in patients with urothelial carcinoma of the bladder treated with radical cystectomy', Journal of Urology, vol. 190, no. 2, pp. 487-492. https://doi.org/10.1016/j.juro.2013.02.003
Da Silva, Rodrigo Donalisio ; Xylinas, Evanguelos ; Kluth, Luis ; Crivelli, Joseph J. ; Chrystal, James ; Chade, Daher ; Guglielmetti, Giuliano Betoni ; Pycha, Armin ; Lotan, Yair ; Karakiewicz, Pierre I. ; Sun, Maxine ; Fajkovic, Harun ; Zerbib, Marc ; Scherr, Douglas S. ; Shariat, Shahrokh F. / Impact of statin use on oncologic outcomes in patients with urothelial carcinoma of the bladder treated with radical cystectomy. In: Journal of Urology. 2013 ; Vol. 190, No. 2. pp. 487-492.
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abstract = "Purpose: Statins are cholesterol lowering agents used to prevent cardiovascular disease. Evidence suggests a dichotomous effect of statins with cancer inhibiting and promoting properties. To our knowledge the effect of statins on the prognosis of muscle invasive urothelial carcinoma of the bladder remains uninvestigated to date. We tested the hypothesis that statin use impacts oncological outcomes in patients treated with radical cystectomy for urothelial carcinoma of the bladder. Materials and Methods: We retrospectively evaluated the records of 1,502 patients treated with radical cystectomy and pelvic lymphadenectomy without neoadjuvant therapy at a total of 4 institutions. Cox regression models were used to determine the association of statins with disease recurrence and cancer specific mortality. Results: A total of 642 patients (42.7{\%}) were on statins. At a median followup of 34 months 509 patients (33.9{\%}) experienced disease recurrence and 402 (26.8{\%}) had died of urothelial carcinoma of the bladder. Statin users were older (p = 0.003), had a higher body mass index (median 32 vs 28 kg/m2, p <0.001) and were more likely to have positive soft tissue surgical margins (9{\%} vs 4{\%}, p <0.001). On univariable Cox regression analysis statins, female gender, advanced age, higher body mass index, smoking status, tumor stage, tumor grade, soft tissue surgical margin status, lymphovascular invasion, lymph node metastasis and adjuvant chemotherapy were associated with disease recurrence (p ≤0.05) and cancer specific mortality (p ≤0.02). On multivariable Cox regression analysis statin use was not associated with either outcome. Conclusions: Statin users were at higher risk for disease recurrence and cancer specific mortality on univariable but not multivariable analysis. These data do not support modification of statin use in patients with high risk urothelial carcinoma of the bladder who will be treated with radical cystectomy.",
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T1 - Impact of statin use on oncologic outcomes in patients with urothelial carcinoma of the bladder treated with radical cystectomy

AU - Da Silva, Rodrigo Donalisio

AU - Xylinas, Evanguelos

AU - Kluth, Luis

AU - Crivelli, Joseph J.

AU - Chrystal, James

AU - Chade, Daher

AU - Guglielmetti, Giuliano Betoni

AU - Pycha, Armin

AU - Lotan, Yair

AU - Karakiewicz, Pierre I.

AU - Sun, Maxine

AU - Fajkovic, Harun

AU - Zerbib, Marc

AU - Scherr, Douglas S.

AU - Shariat, Shahrokh F.

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N2 - Purpose: Statins are cholesterol lowering agents used to prevent cardiovascular disease. Evidence suggests a dichotomous effect of statins with cancer inhibiting and promoting properties. To our knowledge the effect of statins on the prognosis of muscle invasive urothelial carcinoma of the bladder remains uninvestigated to date. We tested the hypothesis that statin use impacts oncological outcomes in patients treated with radical cystectomy for urothelial carcinoma of the bladder. Materials and Methods: We retrospectively evaluated the records of 1,502 patients treated with radical cystectomy and pelvic lymphadenectomy without neoadjuvant therapy at a total of 4 institutions. Cox regression models were used to determine the association of statins with disease recurrence and cancer specific mortality. Results: A total of 642 patients (42.7%) were on statins. At a median followup of 34 months 509 patients (33.9%) experienced disease recurrence and 402 (26.8%) had died of urothelial carcinoma of the bladder. Statin users were older (p = 0.003), had a higher body mass index (median 32 vs 28 kg/m2, p <0.001) and were more likely to have positive soft tissue surgical margins (9% vs 4%, p <0.001). On univariable Cox regression analysis statins, female gender, advanced age, higher body mass index, smoking status, tumor stage, tumor grade, soft tissue surgical margin status, lymphovascular invasion, lymph node metastasis and adjuvant chemotherapy were associated with disease recurrence (p ≤0.05) and cancer specific mortality (p ≤0.02). On multivariable Cox regression analysis statin use was not associated with either outcome. Conclusions: Statin users were at higher risk for disease recurrence and cancer specific mortality on univariable but not multivariable analysis. These data do not support modification of statin use in patients with high risk urothelial carcinoma of the bladder who will be treated with radical cystectomy.

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