Author + information
- Zhou Yaoyao and
- Shen-Wen Fu
Usage of statins is suggested to decrease the incidence of hepatocellular carcinoma (HCC). When it comes to different statin subtypes, the chemopreventive action remains controversial. We aim to compare the usage of different statins and reduction of HCC risk.
We searched PubMed, Embase.com and Cochrane Library database up to August 10, 2015. Initially, we performed standard pairwise meta-analysis for direct comparisons with a random-effects model. For indirect and mixed comparisons, a Bayesian network meta-analysis was then followed. To rank the treatments for an outcome, we estimated the relative ranking probability of each treatment and obtained the treatment hierarchy of competing interventions using rankograms. Both Egger's test and Begg's test was then performed to evaluate publication bias. Clinical heterogeneity was assessed with the I2 statistics. Small study effects were explored by inspecting comparison-adjusted funnel plots.
We reviewed five observational studies enrolling a total of 87127 patients who received at least two different treatment strategies including rosuvastatin, atorvastatin, simvastatin, pravastatin, fluvastatin, cerivastatin, and lovastatin or observation alone. Direct comparisons showed that usage of atorvastatin (OR 0.63, 95%CI 0.45-0.89) and fluvastatin (OR 0.58, 95%CI 0.40-0.85) could significantly cut the risk of liver cancer. Overall, statistical heterogeneity was moderate. No publication bias or small study effects was found in our analysis. The difference of indirect comparisons between the included regimens is not statistically significant. However, usage of all types of statins, such as fluvastatin (RR 0.55, 95%CI 0.26-1.11), atorvastatin (RR 0.59, 95%CI 0.30-1.16), simvastatin (RR 0.69, 95%CI 0.38-1.25), cerivastatin (RR 0.71, 95%CI 0.19-2.70), pravastatin (RR 0.72, 95%CI 0.37-1.45), lovastatin (RR 0.81, 95%CI 0.34-1.96) and rosuvastatin (RR 0.92, 95%CI 0.44-1.80), appeared to be superior to observation alone. Additionally, fluvastatin showed a trend to more beneficial effects when compared with the six other statins, namely, atorvastatin (RR 0.94, 95% CI 0.44-1.95), simvastatin (RR 0.81, 95% CI 0.38-1.64), cerivastatin (RR 0.77, 95% CI 0.19-3.16), pravastatin (RR 0.76, 95% CI 0.34-1.61), lovastatin (RR 0.68, 95% CI 0.27-1.64). Notably, the probabilities of best treatment for each strategy in the prevention of HCC were ranked, which suggested that fluvastatin was also hierarchically the best when compared with other statins.
Our analyses indicate the superiority of usage of statins in reduction of liver cancer. Available evidence supports that fluvastatin is the most effective strategy for reducing HCC risk compared with other statin interventions. Our analysis may contribute clinical decision making regarding appropriate statins treatment for patients with a high risk of HCC.