SNFGE SNFGE
 
Thématique :
- Cancers autres (hors CCR et CHC)
- Oesophage/Estomac
Originalité :
Très original
Solidité :
A confirmer
Doit faire évoluer notre pratique :
Pas encore
 
 
Nom du veilleur :
Docteur Roger FAROUX
Coup de coeur :
 
 
Gastroenterology
  2016/05  
 
  2016 Apr;150(4):854-865.e1  
  doi: 10.1053/j.gastro.2015.12.039  
 
  Association Between Statin Use After Diagnosis of Esophageal Cancer and Survival: A Population-Based Cohort Study.  
 
  Alexandre L, Clark AB, Bhutta HY, Chan SS, Lewis MP, Hart AR  
  http://www.ncbi.nlm.nih.gov/pubmed/?term=Association+Between+Statin+Use+After+Diagnosis+of+Esophageal+Cancer+and+Survival%3A+A+Population-Based+Cohort+Study.  
 
 

BACKGROUND & AIMS:

Statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors), commonly prescribed in the primary and secondary prevention of cardiovascular disease, promote apoptosis and limit proliferation of esophageal cancer cell lines. We investigated whether statin use after a diagnosis of esophageal cancer is associated with reduced esophageal cancer-specific and all-cause mortality.

METHODS:

We identified a cohort of 4445 men and women in the United Kingdom diagnosed with esophageal cancer from January 2000 through November 2009 using the General Practice Research Database. The National Cancer Registry and Office of National Statistics datasets established the histologic subtype and cancer-specific mortality, respectively. Cox proportional hazard regression analysis with time-dependent exposures estimated the association between statin use after diagnosis and esophageal cancer-specific and all-cause mortality.

RESULTS:

The median survival time of the entire cohort was 9.2 months (interquartile range [IQR], 3.7-23.2 mo). Among subjects who used statins after a diagnosis of esophageal cancer, the median survival time was 14.9 months (IQR, 7.1-52.3 mo) compared with 8.1 months for nonusers (IQR, 3.3-20 mo). In the entire cohort, statin use after diagnosis was associated with a decreased risk of esophageal cancer-specific mortality (adjusted hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.44-0.86) and all-cause mortality (HR, 0.67; 95% CI, 0.58-0.77). In patients with esophageal adenocarcinoma, statin use after diagnosis was associated with a decreased risk of esophageal cancer-specific mortality (HR, 0.61; 95% CI 0.38-0.96) and all-cause mortality (HR, 0.63; 95% 0.43-0.92). This effect was not observed in patients with esophageal squamous cell carcinoma. There was no evidence for effect modification of these associations with statin use before the cancer diagnosis.

CONCLUSIONS:

In a large population-based cohort, statin use after a diagnosis of esophageal adenocarcinoma, but not esophageal squamous cell carcinoma, was associated with reduced esophageal cancer-specific and all-cause mortality.

 
Question posée
 
L’utilisation des statines, après le diagnostic d’adénocarcinome a-t-elle un effet sur la survie ?
 
Question posée
 
Dans cette étude de registre exploitant les données de 1165 cancers de l’œsophage , l’utilisation des statines après le diagnostic d’adénocarcinome de l’œsophage réduit le risque de mortalité liée au cancer de 39%. Cet effet n’est pas retrouvé pour les épidermoïdes.
 
Commentaires

Ces résultats sont cohérents avec des travaux expérimentaux  montrant que les statines réduisent la prolifération des lignées cellulaires d’adénocarcinome sur EBO et sont des promoteurs de l’apoptose. Ils  devront être confirmés par d’autres larges cohortes mais pourraient ouvrir la voie  à des essais utilisant les statines en adjuvant des cancers de l’œsophage.

 
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