Statins could be first preventive treatment for liver cancer

Statins may reduce the risk for hepatocellular carcinoma (HCC), show the results of a meta-analysis.

The authors found the effect to be strongest in men of East Asian origin with hepatitis B virus (HBV)-related cirrhosis, indicating that the drugs could be used as chemoprevention in this population.

The meta-analysis, published in Gastroenterology, included seven observational studies and three studies of pooled data from randomized trials. Overall, there were 4298 cases of HCC in 1,459,417 patients.

William Sanchez (Mayo Clinic, Rochester, Minnesota, USA) and colleagues found that the risk for developing HCC was 41% lower among patients who took statins compared with those who did not.

However, when they analyzed the results by location, the reduction was 48% among Asian patients compared with 33% in Western patients.

Hepatitis B is a major risk factor for HCC in Asia and half of all deaths from the disease occur in China, whereas the metabolic syndrome is the main cause of HCC in the West. The authors note that statins have an antagonistic effect on carcinogenic pathways, including those involved in the development of HCC. They say this could explain the difference in the effect of statin use in Asian and Western populations.

Sanchez and colleagues estimate that 5209 East Asian men would need to be treated with statins to prevent one case of HCC. However, in East Asian men with chronic HBV-associated cirrhosis, this decreased to 57.

Based on their findings, Sanchez and colleagues suggest statins could have a protective role in high-risk populations for whom there are currently no chemopreventive agents available.

"With such a high number needed to treat with statins to prevent one case of HCC, it does not seem prudent to prescribe statins for chemoprevention," they write. "However, in patients with multiple risk factors (e.g. East Asian men with chronic HBV infection), statins may have a clinically relevant chemo-protective effect against HCC."

"Future randomized clinical trials or prospective cohort studies in populations at high risk for HCC (especially, in the Asian HBV-infected population) are warranted," they conclude.

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