Statin use reduces radiation-induced stroke risk in advanced nasopharyngeal carcinoma patients

Chuan-Yi Lin; Chia-Lun Chang; Kuan-Chou Lin; Wan-Ming Chen; Ben-Chang Shia; Po-Hsiu Kuo; Szu-Yuan Wu

doi:10.1016/j.radonc.2023.110067

Statin use reduces radiation-induced stroke risk in advanced nasopharyngeal carcinoma patients

Radiother Oncol. 2024 Feb:191:110067. doi: 10.1016/j.radonc.2023.110067. Epub 2023 Dec 23.

Authors

Chuan-Yi Lin¹, Chia-Lun Chang², Kuan-Chou Lin³, Wan-Ming Chen⁴, Ben-Chang Shia⁴, Po-Hsiu Kuo⁵, Szu-Yuan Wu⁶

Affiliations

¹ Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan, ROC; Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan, ROC; Department of Otorhinolaryngology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan, ROC.
² Department of Hemato-Oncology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, ROC; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC.
³ Division of Oral and Maxillofacial Surgery, Department of Dentistry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, ROC; School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan, ROC.
⁴ Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan, ROC; Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan, ROC.
⁵ Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan, ROC; Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan, ROC. Electronic address: phkuo@ntu.edu.tw.
⁶ Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan, ROC; Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan, ROC; Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan, ROC; Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan, ROC; Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan, ROC; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan, ROC; Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan, ROC; Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, ROC; Department of Management, College of Management, Fo Guang University, Yilan, Taiwan, ROC. Electronic address: szuyuanwu5399@gmail.com.

PMID: 38142934
DOI: 10.1016/j.radonc.2023.110067

Abstract

Objective: This cohort study aimed to evaluate the impact of statin use on ischemic stroke risk in patients with advanced nasopharyngeal carcinoma (NPC) undergoing standard concurrent chemoradiotherapy (CCRT).

Methods: Using data from the Taiwan Cancer Registry Database, we conducted an inverse probability of treatment-weighted Cox regression analysis to examine the association between statin use during CCRT and ischemic stroke risk.

Results: The adjusted hazard ratio (aHR) for ischemic stroke in the statin group compared to the non-statin group was 0.70 (95 % CI: 0.54-0.92; P < 0.0107). This protective effect was observed across different statin classes, with hydrophilic statins such as pravastatin showing an aHR of 0.37 (95 % CI: 0.17-0.85) and lipophilic statins including atorvastatin displaying an aHR of 0.32 (95 % CI: 0.21-0.50) compared to non-statin use. Analysis of cumulative defined daily doses (cDDD) revealed a dose-response relationship, with lower stroke risk observed in higher quartiles of cDDD. Additionally, patients with a daily defined dose (DDD) > 1 had a reduced risk of stroke with an aHR of 0.49 (95 % CI: 0.31-0.63), while those with DDD ≤ 1 showed an aHR of 0.59 (95 % CI: 0.40-0.84).

Conclusions: Our study provides evidence supporting the beneficial effects of statin use during the CCRT period in reducing radiation-induced stroke risk among patients with advanced NPC undergoing definitive CCRT. Notably, pravastatin and atorvastatin demonstrated significant reductions in stroke occurrence. Furthermore, the findings suggest a dose-response relationship, where higher cumulative doses and greater daily dose intensity of statin use were associated with a lower risk of stroke.

Keywords: Concurrent chemoradiotherapy; Dose–response relationship; Nasopharyngeal cancer; Radiation induced stroke; Statin.

MeSH terms

Atorvastatin / therapeutic use
Cohort Studies
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors* / therapeutic use
Ischemic Stroke* / complications
Ischemic Stroke* / drug therapy
Nasopharyngeal Carcinoma / pathology
Nasopharyngeal Neoplasms* / pathology
Pravastatin / therapeutic use
Stroke* / epidemiology
Stroke* / etiology
Stroke* / prevention & control

Substances

Hydroxymethylglutaryl-CoA Reductase Inhibitors
Atorvastatin
Pravastatin