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.