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Colon
Original article
Statins reduce the progression of non-advanced adenomas to colorectal cancer: a postcolonoscopy study in 187 897 patients
  1. Ka-Shing Cheung1,
  2. Lijia Chen1,
  3. Esther W Chan2,
  4. Wai-Kay Seto1,
  5. Ian C K Wong2,3,
  6. Wai K Leung1
  1. 1 Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
  2. 2 Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, Hong Kong
  3. 3 UCL School of Pharmacy, UCL, London, UK
  1. Correspondence to Prof Wai K Leung, Department of Medicine, University of Hong Kong, Hong Kong; waikleung{at}hku.hk

Abstract

Background and aims Postcolonoscopy colorectal cancer (PCCRC) accounts for up to 9% of all CRCs. Statins have been shown to be associated with a lower CRC risk. We aimed to investigate whether PCCRC risk was also lower among statin users.

Methods This is a retrospective cohort study using a territory-wide electronic healthcare database in Hong Kong including patients aged 40 years or above who had undergone colonoscopies between 2005 and 2013. Exclusion criteria included prior colorectal cancer (CRC), inflammatory bowel disease, prior colectomy and CRC detected within 6 months of index colonoscopy. We defined statin use as at least 90-day use before index colonoscopy. Medication use was traced up to 5 years before index colonoscopy. PCCRC-3y was defined as cancer diagnosed between 6 and 36 months after index colonoscopy. Sites of CRC were categorised as proximal (proximal to splenic flexure) and distal cancer. The subdistribution HR (SHR) of PCCRC-3y with statin use was derived by propensity score matching based on covariates (including patient factors, concurrent medication use and endoscopy centre’s performance).

Results Of 187 897 eligible subjects, 854 (0.45%) were diagnosed with PCCRC-3y. Statin use was associated with a lower PCCRC-3y risk (SHR: 0.72; 95% CI 0.55 to 0.95; p=0.018). Subgroup analysis shows that SHRs were 0.50 (95% CI 0.28 to 0.91; p=0.022) for proximal and 0.80 (95% CI 0.59 to 1.09; p=0.160) for distal cancer. Older (>60 years) patients, women and those without diabetes mellitus or polyps appeared to benefit more from statins.

Conclusions Statins were associated with a lower PCCRC risk, particularly for proximal cancer.

  • colonic neoplasms
  • colonoscopy
  • colorectal cancer
  • adenocarcinoma

https://doi.org/10.1136/gutjnl-2018-317714

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    Footnotes

    • Contributors K-SC was involved with study concept and design; analysis and interpretation of data; drafting of manuscript; and approval of the final version of the manuscript. EWC, LC and W-KS were involved with acquisition of data; critical revision of the manuscript for important intellectual content; and approval of the final version of the manuscript. ICKW and WKL were involved with the study concept and design; analysis and interpretation of data; drafting of manuscript; critical revision of the manuscript for important intellectual content; study supervision; and approval of the final version of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Ethics approval The study was approved by the Institutional Review Board of the University of Hong Kong and Hospital Authority Hong Kong West Cluster (reference no: UW 18–253).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Not required.