Monday July 01, 2019 from 09:10 to 10:10
Statin use and mortality in bladder cancer patients undergoing radical cystectomy in Quebec, 2000–2014
Michel Wissing1,2, Ana O'Flaherty1, Alice Dragomir1, Simon Tanguay1, Wassim Kassouf1, Armen G. Aprikian1,2.
1Surgery, McGill University Health Centre, Montréal, QC, Canada; 2Oncology, McGill University, Montréal, QC, Canada
Introduction: Bladder cancer (BCa) patients who use statins may have a better outcome, but the topic remains controversial, as biases may have affected results.1-5 We studied the association of statin use with overall (OS) and disease-specific survival (DSS) in a Quebec cohort.
Methods: Using provincial health administrative databases, we identified all BCa patients who underwent radical cystectomy (RC) in Quebec from 2000–2014, and collected data from two years before RC to September 2016 or death. Survival analyses were conducted using the Kaplan-Meier method, log-rank tests, and Cox proportional hazard models. Covariates in the multivariable analyses were age, sex, Charlson’s comorbidity index, region of residence, year of RC, distance to hospital, hospital type (academic), hospital’s and surgeon’s RC volume, neoadjuvant chemotherapy, and type of bladder diversion. We compared patients who received a statin before RC or within a year following RC to never-statin users. To eliminate immortal time bias, we conducted a subgroup analysis excluding patients who died <1 year of RC.
Results: Of 3087 BCa patients included, 1448 (46.9%) were statin users. Median OS and DSS were 2.5 years (95% confidence interval [CI] 2.1–2.8) and 4.6 years (95% CI 3.5–5.5) for non-statin users, respectively, vs.4.5 years (95% CI 3.6–5.4) and 10.7 years (95% CI 9.1–not reached) for statin users (p<0.001). In multivariable analyses, hazard ratios (HR) for death and DSM were 0.83 (95% CI 0.75–0.91) and 0.81 (95% CI 0.71–0.91), respectively, for statin users. A total of 2215 patients (71.8%) had a followup >1 year post-RC, of whom 1082 (48.8%) were statin users. Adjusted HR for death and DSM were 0.81 (95% CI 0.71–0.94) and 0.81 (95% CI 0.69–0.96), respectively, in this subgroup. OS/DSS did not differ between patients who started statins after RC compared to those who already used statins before RC (adjusted HR 1.14; 95% CI 0.80–1.64 and 1.11; 95%CI 0.72–1.70, respectively)
Conclusions: Statin users had improved OS and DSS in our large BCa cohort.
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