Objective: 3-hydroxy-3-methyl-glutaryl-CoA (HMG-CoA) reductase inhibitors, or statins, are common therapeutic agents in the management of dyslipidemias. Epidemiologic and pharmacologic data also suggest statins have an effect on cancer biology. We sought to determine the association between use of statins and epithelial ovarian cancer survival, disease progression, and clinico-pathologic factors.
Methods: After IRB approval, we performed a retrospective review of all patients with advanced stage (III/IV) epithelial ovarian or primary peritoneal cancer undergoing primary cytoreductive surgery by a gynecologist oncologist between 6/1996 and 6/2001. Abstracted data included statin use at time of initial cytoreductive surgery, as well as clinico-pathologic factors and survival. Statistical analysis included Fisher's exact test, Kaplan-Meier survival, and Cox regression analyses.
Results: 126 patients met criteria for review. Seventeen (14%) patients were undergoing concurrent statin therapy at time of initial cytoreductive surgery. Statin users were statistically older (median age 67 years, versus 60 years for non-users, p=0.002) and had a greater incidence of diabetes mellitus (18% versus 3% in non-users, p=0.03). Of the entire cohort, 21 patients (17%) were suboptimally cytoreduced after initial surgery, with residual disease N1 cm; statin use did not correlate with incidence of optimal resection (p=0.3). Median progression-free survival for statin users was 24 months, compared to 16 months for statin non-users (p=0.007). Similarly, overall survival was significantly longer for statin users (62 months) compared to statin non-users (46 months, p=0.04). Multivariable analysis identified statin use as an independent positive prognostic factor, after controlling for age, stage, grade, and suboptimal cytoreduction (p=0.02).
Conclusions: These data indicate statin use in patients diagnosed with epithelial ovarian cancer is associated with improved survival, and suggest a potential suppressive impact of HMG-CoA reductase inhibitors on tumor biology. Studies are proposed to explore the molecular mechanisms underlying these clinical observations.