Podium Session 4: Mixed Oncology

Monday July 01, 2019 from 09:10 to 10:10

Room: QCCC - 2000A

POD-4.3 Statin use and mortality in bladder cancer patients undergoing radical cystectomy in Quebec province, 2000-2014

Armen G. Aprikian, Canada

Professor
Urology
McGill University

Abstract

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.

References:

[1] Pastore A, Palleschi G, Fuschi A, et al. Can daily intake of aspirin and/or statins influence the behaviour of non-muscle invasive bladder cancer? A retrospective study on a cohort of patients undergoing transurethral bladder resection. BMC Cancer 2015;15:120. https://doi.org/10.1186/s12885-015-1152-x
[2] Richard PO, Ahmad AE, Bashir S, et al. Effect of statins as a secondary chemopreventive agent among individuals with non-muscle-invasive bladder cancer: A population-based analysis. Urol Oncol 2017;35:342-8. https://doi.org/10.1016/j.urolonc.2016.12.009
[3] Crivelli JJ, Xylinas E, Kluth LA, et al. Effect of statin use on outcomes of non-muscle-invasive bladder cancer. BJU Int 2013;112:E4-12. https://doi.org/10.1111/bju.12150
[4] Emilsson L, Garcia-Albeniz X, Logan RW, et al. Examining bias in studies of statin treatment and survival in patients with cancer. JAMA Oncol 2018;4:63-70. https://doi.org/10.1001/jamaoncol.2017.2752
[5] da Silva RD, Xylinas E, Kluth L, et al. Impact of statin use on oncologic outcomes in patients with urothelial carcinoma of the bladder treated with radical cystectomy. J Urol 2013;190:487-92. https://doi.org/10.1016/j.juro.2013.02.003



© 2019 CUA 74th Annual Meeting