TY - JOUR
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.
PY - 2013/8
Y1 - 2013/8
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.
AB - 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.
KW - hydroxymethylglutaryl-CoA reductase inhibitors
KW - mortality
KW - neoplasm recurrence
KW - urinary bladder
KW - urinary bladder neoplasms
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UR - http://www.scopus.com/inward/citedby.url?scp=84880037409&partnerID=8YFLogxK
U2 - 10.1016/j.juro.2013.02.003
DO - 10.1016/j.juro.2013.02.003
M3 - Article
C2 - 23395802
AN - SCOPUS:84880037409
SN - 0022-5347
VL - 190
SP - 487
EP - 492
JO - Journal of Urology
JF - Journal of Urology
IS - 2
ER -