Statins and metachronous recurrence after endoscopic resection of early gastric cancer: a nationwide Korean cohort study

Abstract

Background

Statins have shown to reduce the risk of various cancers. However, their effects on metachronous recurrence (MR) after endoscopic resection (ER) for early gastric cancer (EGC) are unknown. We evaluate their effects on MR development after ER for EGC.

Methods

We selected 11,568 patients who received ER for EGC from 2002 to 2011 from the Korean National Health Insurance database and classified into 2 groups: control and statins using propensity score matching. Metachronous recurrence was defined as the second ER or gastrectomy performed 6 months after the first ER.

Results

Mean follow-up period was 8.8 ± 3.1 years. Statins showed a significantly lower incidence of MR than the control group (12.5% vs 2.2%, respectively, P < 0.01). After conducting competing risk analyses and time-dependent cox regression analysis considering immortal time bias, statins still showed a lower incidence rate of MR compared to that observed in the control group. For the multivariate analysis, statins remained significant (HR 0.17; 95% CI 0.13–0.24, P < 0.01). In the dose–response analysis, an inverse dose–response relationship was identified between MR and statins (P < 0.01).

Conclusion

Statins was significantly associated with a reduced risk of MR after ER for EGC with an inverse dose–response relationship.

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Fig. 1
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Abbreviations

ADDD:

Average DDD

BMI:

Body mass index

CI:

Confidence intervals

DDD:

Defined daily dose

EGC:

Early gastric cancer

EMR:

Endoscopic mucosal resection

ER:

Endoscopic resection

ESD:

Endoscopic submucosal dissection

H. pylori :

Helicobacter pylori

HR:

Hazard ratio

ICD-10:

International classification of disease 10th revision

KCCR:

Korean Central Cancer Registry

NHIS:

National Health Insurance Service

MR:

Metachronous recurrence

OR:

Odds ratio

PSM:

Propensity score-matching

SD:

Standard deviation

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Acknowledgements

The authors thank the staff of the National Health Insurance Service.

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Correspondence to Sang Kil Lee or Sang Gyun Kim.

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Chung, H., Kim, H.J., Jung, H.C. et al. Statins and metachronous recurrence after endoscopic resection of early gastric cancer: a nationwide Korean cohort study. Gastric Cancer 23, 659–666 (2020). https://doi.org/10.1007/s10120-020-01041-z

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Keywords

  • Medication
  • Recurrence
  • Stomach neoplasm
  • Endoscopic treatment