Statin Use During Concurrent Chemoradiotherapy With Improved Survival Outcomes in Esophageal Squamous Cell Carcinoma: A Propensity Score-Matched Nationwide Cohort Study

Wan-Ming Chen; Ying-Hui Yu; Mingchih Chen; Ben-Chang Shia; Szu-Yuan Wu

doi:10.1016/j.jtho.2023.04.005

Statin Use During Concurrent Chemoradiotherapy With Improved Survival Outcomes in Esophageal Squamous Cell Carcinoma: A Propensity Score-Matched Nationwide Cohort Study

J Thorac Oncol. 2023 Aug;18(8):1082-1093. doi: 10.1016/j.jtho.2023.04.005. Epub 2023 Apr 20.

Authors

Wan-Ming Chen¹, Ying-Hui Yu², Mingchih Chen¹, Ben-Chang Shia¹, Szu-Yuan Wu³

Affiliations

¹ Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan; Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan.
² Department of Colorectal Surgery, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan.
³ Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan; Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan; Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan; Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan; Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan; Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan; Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Management, College of Management, Fo Guang University, Yilan, Taiwan. Electronic address: szuyuanwu5399@gmail.com.

PMID: 37085031
DOI: 10.1016/j.jtho.2023.04.005

Abstract

Introduction: To determine the effect of statin use during concurrent chemoradiotherapy (CCRT) on overall survival and esophageal squamous cell carcinoma (ESCC)-specific survival in patients with ESCC receiving standard CCRT.

Methods: In this propensity score-matching cohort study, we used data from the Taiwan Cancer Registry Database and National Health Insurance Research Database to investigate the effects of statin use during the period of CCRT on overall survival and ESCC-specific survival.

Results: Statin use during the period of CCRT was found to be a considerable and independent prognostic factor for overall survival and ESCC-specific survival. The adjusted hazard ratio (aHR) for all-cause mortality in the statin group compared with that of the non-statin group was 0.65 (95% confidence interval: 0.51-0.84, p = 0.0009). The aHR for ESCC-specific mortality in the statin group compared with that of the non-statin group was 0.63 (95% confidence interval: 0.47-0.84, p = 0.0016). The use of hydrophilic statins such as rosuvastatin and pravastatin was associated with the greatest survival benefits. A dose-response relationship was also found, with higher cumulative defined daily doses and higher daily intensity of statin use associated with lower mortality.

Conclusions: This study is the first to reveal that statin use during the period of CCRT for ESCC is associated with improvement in overall survival and ESCC-specific survival. In addition, we found that use of rosuvastatin, pravastatin, and simvastatin was associated with better survival outcomes for patients with ESCC receiving CCRT. Furthermore, we found a dose-response relationship of statin use associated with lower ESCC-specific mortality.

Keywords: Concurrent chemoradiotherapy; Dose-response relationship; Esophageal squamous cell carcinoma; Statin; Survival.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Carcinoma, Squamous Cell* / drug therapy
Chemoradiotherapy / adverse effects
Cohort Studies
Esophageal Neoplasms* / therapy
Esophageal Squamous Cell Carcinoma* / etiology
Esophageal Squamous Cell Carcinoma* / therapy
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors* / therapeutic use
Lung Neoplasms* / drug therapy
Pravastatin / therapeutic use
Propensity Score
Rosuvastatin Calcium / therapeutic use

Substances

Hydroxymethylglutaryl-CoA Reductase Inhibitors
Rosuvastatin Calcium
Pravastatin