Research Article Open Access

The Impact of Statin Therapy on the Recurrence of Early-Stage Estrogen Receptor-Positive Breast Cancer: A Meta-Analysis

Abstract

Abstract: Statins have been recognized for their significant role in mitigating drug resistance to endocrine therapy in breast cancer. A substantial body of research has indicated that statin usage is associated with a marked improvement in both overall survival rates and Breast Cancer-Specific Survival (BCSS) among patients. The objective of this research is to determine whether the use of statins influences the local recurrence in early-stage Estrogen Receptor-Positive (ER+) breast cancer patients. This investigation could provide crucial insights into the potential of statins as an adjunct therapy to reduce the risk of recurrence in this patient population. Materials and methods: Our review encompassed three studies comparing the recurrence rates in stage I-III ER+ breast cancer patients who did and did not use statins. The endpoint focused on recurrence, with the inclusion criterion being studies that reported fully adjusted Hazard Ratios (HRs). Summary Odds Ratios (ORs) were derived using random-effects models. Publication bias and heterogeneity were evaluated through sensitivity analyses, Q statistic tests, and I² tests. Results: Three population-based studies, comprising a total of 27163 patients with ER+ breast cancer, were included in our analysis: 4101 of whom were on statin therapy, and 23062 were not. The pooled OR revealed a notably significant 52% reduction in the risk of recurrence for patients who used statins compared to those who did not (Summary OR=0.43; 95% CI: 0.27–0.70, P=0.0006). Our analysis of three population-based studies, demonstrates a significant 57% reduction in recurrence risk for early-stage ER+ breast cancer patients treated with statins. However, it is crucial to acknowledge the substantial heterogeneity present among the studies, as indicated by an I² of 94% and a highly significant chi-square test (P <0.00001). Based on the leave-one-out sensitivity analysis plot, all three studies are within the confidence intervals of the overall effect estimate, which can suggest that the meta-analysis results are relatively robust. Regarding publication bias, Egger’s test yielded a P-value of 0.1964, indicating no evidence of small-study effects or publication bias in this meta-analysis. Conclusion: The pooled OR for statin use compared to non-use is 0.43 with a 96% CI of (0.27, 0.70). Despite the considerable variation in ORs and high heterogeneity, the conclusions drawn from the three studies are relatively consistent, indicating that the use of statins indeed reduces the recurrence rate in early-stage ER+ breast cancer patients.

Jia Gao, Yiming Sun, Feng Zhang, Xiaowen Ma*

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