Impact of Statin Use on BCR After Radical Prostatectomy
Impact of Statin Use on BCR After Radical Prostatectomy
Table 1A shows the clinicopathologic characteristics of the 6842 patients and their association with statin use. A total of 2275 (33.3%) were taking statins at the time of RP. Statin users were older (P=0.05) and had a higher rate of positive surgical margins (PSMs; P=0.03) than patients not using statins. There were no significant differences in preoperative PSA, preoperative or RP Gleason sum, extracapsular extension, seminal vesicle invasion and lymph node metastasis between patients who used statins and those who did not.
Within a median FU of 25 months (interquartile range: 8–42), 538 (11.8%) patients without statin use and 240 (10.5%) patients with statin use experienced BCR (Figure 1). Actuarial estimates of BCR-free survival were 92±0%, 82±1% and 66±3% for patients without statin use and 94±1%, 84±1% and 71±3% for patients with statin use at 2, 5 and 10 years, respectively (Figure 1, P=0.05). In univariable cox regression analysis, statin use was associated with a decreased risk of BCR (Table 2, hazard ratio (HR): 0.86, 95% confidence interval (CI): 0.74–1.00, P=0.05). In multivariable analyses, age, preoperative PSA, RP Gleason sum, lymph node metastasis, PSMs, stage pT3a and pT3b were significantly associated with risk of recurrence, whereas statin use did not retain its significance (Table 2, HR: 0.88, 95% CI: 0.76–1.03, P=0.10).
(Enlarge Image)
Figure 1.
Kaplan–Meier curves depicting biochemical recurrence-free survival in 6842 patients with clinically localized prostate cancer treated with radical prostatectomy according to their statin use.
In subgroup analysis of patients with PSM, 184 (28.3%) patients who did not take statins and 75 (20.2%) patients who took statins experienced BCR within a median FU of 26 months (interquartile range: 8–45). Actuarial estimates of BCR-free survival were 80±2%, 62±3% and 49±4% for patients without statin use and 86±2%, 71±3% and 65±4% for patients with statin use at 2, 5 and 10 years, respectively (Figure 2, P=0.007). In patients with PSM, clinicopathologic features were comparable between statin users and non-statin users (Table 1B). In multivariable cox regression analysis that adjusted for the effects of standard clinicopathologic features, statin use remained significantly associated with decreased risk of BCR (Table 2, HR: 0.76, 95% CI: 0.58–0.99, P=0.046).
(Enlarge Image)
Figure 2.
Kaplan–Meier curves depicting biochemical recurrence-free survival in 1022 patients with clinically localized prostate cancer and positive surgical margins after treated with radical prostatectomy according to their statin use.
BCR-free survival did not show any significant difference between statin users and non-users in patients with RP Gleason sum ≤6 (P=0.39), RP Gleason sum=7 (P=0.20), RP Gleason sum≥8 (P=0.34), without PSM (P=0.36), stage pT3a (P=0.11), stage pT3b (0.12) and with lymph node metastasis (P=0.97).
Results
Association of Statin Use With Clinicopathologic Characteristics
Table 1A shows the clinicopathologic characteristics of the 6842 patients and their association with statin use. A total of 2275 (33.3%) were taking statins at the time of RP. Statin users were older (P=0.05) and had a higher rate of positive surgical margins (PSMs; P=0.03) than patients not using statins. There were no significant differences in preoperative PSA, preoperative or RP Gleason sum, extracapsular extension, seminal vesicle invasion and lymph node metastasis between patients who used statins and those who did not.
Association of Statin Use With BCR in the Entire Cohort
Within a median FU of 25 months (interquartile range: 8–42), 538 (11.8%) patients without statin use and 240 (10.5%) patients with statin use experienced BCR (Figure 1). Actuarial estimates of BCR-free survival were 92±0%, 82±1% and 66±3% for patients without statin use and 94±1%, 84±1% and 71±3% for patients with statin use at 2, 5 and 10 years, respectively (Figure 1, P=0.05). In univariable cox regression analysis, statin use was associated with a decreased risk of BCR (Table 2, hazard ratio (HR): 0.86, 95% confidence interval (CI): 0.74–1.00, P=0.05). In multivariable analyses, age, preoperative PSA, RP Gleason sum, lymph node metastasis, PSMs, stage pT3a and pT3b were significantly associated with risk of recurrence, whereas statin use did not retain its significance (Table 2, HR: 0.88, 95% CI: 0.76–1.03, P=0.10).
(Enlarge Image)
Figure 1.
Kaplan–Meier curves depicting biochemical recurrence-free survival in 6842 patients with clinically localized prostate cancer treated with radical prostatectomy according to their statin use.
Association of Statin Use With BCR in Subgroups
In subgroup analysis of patients with PSM, 184 (28.3%) patients who did not take statins and 75 (20.2%) patients who took statins experienced BCR within a median FU of 26 months (interquartile range: 8–45). Actuarial estimates of BCR-free survival were 80±2%, 62±3% and 49±4% for patients without statin use and 86±2%, 71±3% and 65±4% for patients with statin use at 2, 5 and 10 years, respectively (Figure 2, P=0.007). In patients with PSM, clinicopathologic features were comparable between statin users and non-statin users (Table 1B). In multivariable cox regression analysis that adjusted for the effects of standard clinicopathologic features, statin use remained significantly associated with decreased risk of BCR (Table 2, HR: 0.76, 95% CI: 0.58–0.99, P=0.046).
(Enlarge Image)
Figure 2.
Kaplan–Meier curves depicting biochemical recurrence-free survival in 1022 patients with clinically localized prostate cancer and positive surgical margins after treated with radical prostatectomy according to their statin use.
BCR-free survival did not show any significant difference between statin users and non-users in patients with RP Gleason sum ≤6 (P=0.39), RP Gleason sum=7 (P=0.20), RP Gleason sum≥8 (P=0.34), without PSM (P=0.36), stage pT3a (P=0.11), stage pT3b (0.12) and with lymph node metastasis (P=0.97).
