Statin Use Improves Overall Survival of Patients with Gastric Cancer after Surgery and Adjuvant Chemotherapy in Taiwan: A Nationwide Matched Cohort Study
Abstract
:1. Introduction
2. Results
3. Discussion
4. Materials and Methods
4.1. Data Source
4.2. Study Population
4.3. Study Variables
4.4. Propensity Score Matching
4.5. Sensitivity Analyses
4.6. Statistical Analysis
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Abbreviations
cDDDs | Cumulative defined daily doses |
GC | gastric cancer |
CI | confidence interval |
H. pylori | Helicobacter pylori |
HMG-CoA | 3-hydroxy-3-methylglutaryl-coenzyme A |
OS | overall survival |
NHIRD | National Health Insurance Research Database |
RCIPD | Registry of Catastrophic Illness Patients Database |
ICD-9-CM | International Classification of Diseases, Ninth Revision, Clinical Modification |
ACE | angiotensin-converting enzyme |
NSAID | non-steroidal anti-inflammatory drug |
PS | propensity score |
HR | hazard ratio |
Cag A | cytotoxin-associated gene A |
HDAC2 | histone deacetylase 2 |
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Variables | Statin Users (N = 367) | Statin Non-Users (N = 1468) | p-Value * | ||
---|---|---|---|---|---|
No. | % | No. | % | ||
Gender | 0.5543 | ||||
Female | 159 | 43.3 | 611 | 41.6 | |
Male | 208 | 56.7 | 857 | 58.4 | |
Age at Surgery | 0.4388 | ||||
18–64 | 172 | 46.9 | 655 | 44.6 | |
≥65 | 195 | 53.1 | 813 | 55.4 | |
Mean (SD) | 64.3 (10.5) | 64.1 (12.6) | 0.758 | ||
Insured Salaries (NTD$/month) a | |||||
0+ | 70 | 19.1 | 277 | 18.9 | |
1–15,840 | 38 | 10.4 | 154 | 10.5 | |
15,841–25,000 | 185 | 50.4 | 733 | 49.9 | |
>25,000 | 74 | 20.2 | 304 | 20.7 | |
Urbanization Level | 0.5232 | ||||
Very High | 106 | 28.9 | 395 | 26.9 | |
High | 170 | 46.3 | 737 | 50.2 | |
Moderate | 62 | 16.9 | 241 | 16.4 | |
Low | 29 | 7.9 | 95 | 6.5 | |
Comorbidities | |||||
Hypertension | 214 | 58.3 | 878 | 59.8 | 0.6009 |
Diabetes Mellitus | 122 | 33.2 | 467 | 31.8 | 0.5996 |
Alcoholism | 8 | 2.2 | 23 | 1.6 | 0.4150 |
Smoking-related disorder | 40 | 10.9 | 166 | 11.3 | 0.8244 |
Chronic kidney disease | 13 | 3.5 | 64 | 4.4 | 0.4848 |
Liver cirrhosis | 14 | 3.8 | 61 | 4.2 | 0.7682 |
Chemotherapy Regimen | 0.9425 | ||||
Group 1 (epirubicin-based) | 29 | 7.9 | 105 | 7.2 | |
Group 2 (mitomycin-based) | 49 | 13.4 | 205 | 14.0 | |
Group 3 (taxanes) | 2 | 0.5 | 10 | 0.7 | |
Group 4 (others) b | 287 | 78.2 | 1148 | 78.2 | |
Medication | |||||
Triglyceride-Lowering Drugs | 0.0046 | ||||
User | 19 | 5.2 | 35 | 2.4 | |
Non-user | 348 | 94.8 | 1433 | 97.6 | |
Non-Statin Lipid-Lowering Drugs | 0.4756 | ||||
User | 8 | 2.2 | 24 | 1.6 | |
Non-user | 359 | 97.8 | 1444 | 98.4 | |
ACE Inhibitors | 0.9579 | ||||
User | 98 | 26.7 | 390 | 26.6 | |
Non-user | 269 | 73.3 | 1078 | 73.4 | |
Aspirin | 0.3669 | ||||
User | 123 | 33.5 | 529 | 36.0 | |
Non-user | 244 | 66.5 | 939 | 64.0 | |
NSAID | 0.7487 | ||||
User | 291 | 79.3 | 1175 | 80.0 | |
Non-user | 76 | 20.7 | 293 | 20.0 | |
Death | 138 | 37.6 | 895 | 61.0 |
Variables | 28–167 cDDD | ≥168 cDDD | ||||||
---|---|---|---|---|---|---|---|---|
HR | 95% CI | p-Value | HR | 95% CI | p-Value | |||
Main Model * | 0.62 | 0.50 | 0.78 | <0.0001 | 0.34 | 0.26 | 0.45 | <0.0001 |
Additional Covariates † | ||||||||
Main model + Diabetes mellitus | 0.64 | 0.51 | 0.80 | <0.0001 | 0.33 | 0.25 | 0.44 | <0.0001 |
Main model + Hypertension | 0.62 | 0.50 | 0.78 | <0.0001 | 0.34 | 0.26 | 0.45 | <0.0001 |
Main model + Alcoholism | 0.62 | 0.50 | 0.78 | <0.0001 | 0.34 | 0.26 | 0.45 | <0.0001 |
Main model + Smoking-related disorder | 0.62 | 0.50 | 0.78 | <0.0001 | 0.34 | 0.26 | 0.45 | <0.0001 |
Main model + Chronic renal failure | 0.62 | 0.50 | 0.78 | <0.0001 | 0.34 | 0.26 | 0.45 | <0.0001 |
Main model + Liver cirrhosis | 0.62 | 0.50 | 0.77 | <0.0001 | 0.34 | 0.26 | 0.45 | <0.0001 |
Main model + Chemotherapy regimen | 0.63 | 0.50 | 0.78 | <0.0001 | 0.33 | 0.25 | 0.44 | <0.0001 |
Main model + Triglyceride-lowering drugs | 0.62 | 0.50 | 0.78 | <0.0001 | 0.35 | 0.26 | 0.46 | <0.0001 |
Main model + Non-statin lipid-lowering drugs | 0.62 | 0.50 | 0.78 | <0.0001 | 0.34 | 0.26 | 0.45 | <0.0001 |
Main model + ACE inhibitors | 0.61 | 0.49 | 0.76 | <0.0001 | 0.34 | 0.26 | 0.45 | <0.0001 |
Main model + Aspirin | 0.60 | 0.48 | 0.75 | <0.0001 | 0.33 | 0.25 | 0.44 | <0.0001 |
Main model + NSAID | 0.60 | 0.48 | 0.75 | <0.0001 | 0.32 | 0.24 | 0.43 | <0.0001 |
Subgroup Effects | ||||||||
Sex | ||||||||
Male | 0.76 | 0.57 | 1.02 | 0.0674 | 0.41 | 0.30 | 0.57 | <0.0001 |
Female | 0.49 | 0.35 | 0.70 | <0.0001 | 0.23 | 0.14 | 0.40 | <0.0001 |
Age at Surgery | ||||||||
18–64 | 0.46 | 0.31 | 0.67 | <0.0001 | 0.24 | 0.14 | 0.41 | <0.0001 |
≥65 | 0.75 | 0.57 | 0.99 | 0.0402 | 0.40 | 0.29 | 0.55 | <0.0001 |
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Yang, P.-R.; Tsai, Y.-Y.; Chen, K.-J.; Yang, Y.-H.; Shih, W.-T. Statin Use Improves Overall Survival of Patients with Gastric Cancer after Surgery and Adjuvant Chemotherapy in Taiwan: A Nationwide Matched Cohort Study. Cancers 2020, 12, 2055. https://doi.org/10.3390/cancers12082055
Yang P-R, Tsai Y-Y, Chen K-J, Yang Y-H, Shih W-T. Statin Use Improves Overall Survival of Patients with Gastric Cancer after Surgery and Adjuvant Chemotherapy in Taiwan: A Nationwide Matched Cohort Study. Cancers. 2020; 12(8):2055. https://doi.org/10.3390/cancers12082055
Chicago/Turabian StyleYang, Pei-Rung, Ying-Ying Tsai, Ko-Jung Chen, Yao-Hsu Yang, and Wei-Tai Shih. 2020. "Statin Use Improves Overall Survival of Patients with Gastric Cancer after Surgery and Adjuvant Chemotherapy in Taiwan: A Nationwide Matched Cohort Study" Cancers 12, no. 8: 2055. https://doi.org/10.3390/cancers12082055