Samuel D Kaffenberger1, Opal Lin-Tsai2, Kelly L Stratton3, Todd M Morgan4, Daniel A Barocas5, Sam S Chang6, Michael S Cookson7, S Duke Herrell6, Joseph A Smith6, Peter E Clark6. 1. Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN. Electronic address: kaffenbs@mskcc.org. 2. Vanderbilt University School of Medicine, Nashville, TN. 3. Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN; Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY. 4. Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN; Department of Urology, University of Michigan Health System, Ann Arbor, MI. 5. Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN; Center for Surgical Quality and Outcomes Research, Vanderbilt University Medical Center, Nashville, TN. 6. Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN. 7. Department of Urology, University of Oklahoma College of Medicine, Oklahoma City, OK.
Abstract
PURPOSE: To determine whether statin use at time of surgery is associated with survival following nephrectomy or partial nephrectomy for renal cell carcinoma (RCC). Statins are thought to exhibit a protective effect on cancer incidence and possibly cancer survival in a number of malignancies. To date, no studies have shown an independent association between statin use and mortality in RCC. METHODS: A retrospective cohort study of 916 patients who underwent radical or partial nephrectomy for RCC from 2000 to 2010 at a single institution was performed. Primary outcomes were overall (OS) and disease-specific survival (DSS). Univariable survival analyses were performed using the Kaplan-Meier and the log-rank methods. Multivariable analysis was performed using a Cox proportional hazards model. The predictive discrimination of the models was assessed using the Harrell c-index. RESULTS: The median follow-up of the entire cohort was 42.5 months. The 3-year OS estimate was 83.1% (95% CI: 77.6%-87.3%) for statin users and 77.3% (95% CI: 73.7%-80.6%) for nonstatin users (P = 0.53). The 3-year DSS was 90.9% (95% CI: 86.3%-94.0%) for statin users and 83.5% (95% CI: 80.1%-86.3%) for nonstatin users (P = 0.015). After controlling for age, American Society of Anesthesiology class, pT category, pN category, metastatic status, preoperative anemia and corrected hypercalcemia, and blood type, statin use at time of surgery was independently associated with improved OS (hazard ratio = 0.62; 95% CI: 0.43-0.90; P = 0.011) and DSS (hazard ratio = 0.48; 95% CI: 0.28-0.83; P = 0.009). The multivariable model for DSS had excellent predictive discrimination with a c-index of 0.91. CONCLUSIONS: These data suggest that statin usage at time of surgery is independently associated with improved OS and DSS in patients undergoing surgery for RCC.
PURPOSE: To determine whether statin use at time of surgery is associated with survival following nephrectomy or partial nephrectomy for renal cell carcinoma (RCC). Statins are thought to exhibit a protective effect on cancer incidence and possibly cancer survival in a number of malignancies. To date, no studies have shown an independent association between statin use and mortality in RCC. METHODS: A retrospective cohort study of 916 patients who underwent radical or partial nephrectomy for RCC from 2000 to 2010 at a single institution was performed. Primary outcomes were overall (OS) and disease-specific survival (DSS). Univariable survival analyses were performed using the Kaplan-Meier and the log-rank methods. Multivariable analysis was performed using a Cox proportional hazards model. The predictive discrimination of the models was assessed using the Harrell c-index. RESULTS: The median follow-up of the entire cohort was 42.5 months. The 3-year OS estimate was 83.1% (95% CI: 77.6%-87.3%) for statin users and 77.3% (95% CI: 73.7%-80.6%) for nonstatin users (P = 0.53). The 3-year DSS was 90.9% (95% CI: 86.3%-94.0%) for statin users and 83.5% (95% CI: 80.1%-86.3%) for nonstatin users (P = 0.015). After controlling for age, American Society of Anesthesiology class, pT category, pN category, metastatic status, preoperative anemia and corrected hypercalcemia, and blood type, statin use at time of surgery was independently associated with improved OS (hazard ratio = 0.62; 95% CI: 0.43-0.90; P = 0.011) and DSS (hazard ratio = 0.48; 95% CI: 0.28-0.83; P = 0.009). The multivariable model for DSS had excellent predictive discrimination with a c-index of 0.91. CONCLUSIONS: These data suggest that statin usage at time of surgery is independently associated with improved OS and DSS in patients undergoing surgery for RCC.
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