Original articleSystematic review and meta-analysesStatins Are Associated With Reduced Risk of Esophageal Cancer, Particularly in Patients With Barrett's Esophagus: A Systematic Review and Meta-analysis
Section snippets
Methods
This systematic review was conducted following guidance provided by the Cochrane Handbook20 and Kanwal and White21 and is reported according to the Meta-analysis of Observational Studies in Epidemiology guidelines.22 The process followed a priori established protocol.
Search Results
Of a total 2336 unique studies identified using our search criteria, 13 studies fulfilled our inclusion criteria and were included in the meta-analysis (7 case-control, 5 cohort, and 1 post hoc analysis of 22 RCTs),3, 15, 16, 17, 18, 19, 24, 34, 35, 36, 37, 38, 39, 40, 41 of which 3 had been published only in the abstract form.34, 37, 39 Figure 1 summarizes the process of study identification, inclusion, and exclusion. These cumulatively reported 9285 cases of EC in 1,132,969 patients, who were
Discussion
The identification of potential agents for chemoprevention in EC is highly desirable. Aspirin, NSAIDs, and PPIs may have potential chemopreventive effects in patients with BE but they are not without significant side effects.46, 47 In this comprehensive meta-analysis of all published studies in more than 1.13 million patients with 9285 cases of EC, we found that use of statins is associated with a 28% reduction in the risk of EC, after adjusting for confounding variables, although there was
Conclusions
In summary, a meta-analysis of all studies suggests that statin use is associated with a reduced risk of EC, with greater and most consistent benefit on the risk of EAC in patients with known BE. Longer duration of statin use, in combination with aspirin/NSAIDs, may provide greater protective effect. Given the high mortality rates after a diagnosis of EC, these results support chemoprevention trials evaluating statins in populations at high risk of developing EAC.
Acknowledgment
The authors sincerely thank Dr Andrew Hart for sharing additional information from their original study for the purposes of this meta-analysis.
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Conflicts of interest The authors disclose no conflicts.
Funding Supported in part by the National Institute of Diabetes and Digestive and Kidney Diseases (RC4DK090413) and the American College of Gastroenterology.