This uncommissioned systematic review was subject to full peer-review.
Systematic review: potential preventive effects of statins against oesophageal adenocarcinoma
Version of Record online: 20 JUN 2012
© 2012 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 36, Issue 4, pages 301–311, August 2012
How to Cite
Alexandre, L., Clark, A. B., Cheong, E., Lewis, M. P. N. and Hart, A. R. (2012), Systematic review: potential preventive effects of statins against oesophageal adenocarcinoma. Alimentary Pharmacology & Therapeutics, 36: 301–311. doi: 10.1111/j.1365-2036.2012.05194.x
- Issue online: 16 JUL 2012
- Version of Record online: 20 JUN 2012
- Manuscript Accepted: 4 JUN 2012
- Manuscript Revised: 13 MAY 2012
- Manuscript Revised: 21 FEB 2012
- Manuscript Received: 6 FEB 2012
The incidence of oesophageal adenocarcinoma (OAC) has risen dramatically in recent decades, and its prognosis remains extremely poor. There is emerging evidence that statins may prevent OAC.
To systematically review both the experimental and epidemiological evidence to determine whether statins reduce the risk of developing OAC.
Relevant laboratory and epidemiological studies were identified by systematically searching the PUBMED and EMBASE electronic databases for data on statins and oesophageal cancer (OC). The evidence was assessed according to the nine Bradford Hill criteria (BHC) of causality. Pooled effect sizes (ES) were calculated for the risk of OC with prior statin use.
Many of the BHC were supported including: ‘plausible biological mechanisms’, ‘coherence’, ‘strong associations’, ‘consistency’, ‘biological gradient’, ‘analogy’ and ‘temporality’. Three experimental studies reported that statins inhibited proliferation, induced apoptosis and may limit metastatic potential in OAC cell lines. Fixed effects meta-analysis of two prospective studies in Barrett's oesophagus cohorts, involving 1382 participants, showed an ES of 0.53 (95% CI = 0.36–0.78, P = 0.001, I2 = 0%) for risk of OAC with prior statin use. Meta-analysis of three prospective studies in general population cohorts, involving 35 214 participants, showed an ES of 0.86 (95% CI = 0.78–0.94, P = 0.001, I2 = 0%) for risk of OC with prior statin use. The most important criterion, ‘experiment’, is as yet unfulfilled as to date there are no clinical trials which investigate this hypothesis.
There is some evidence that statins may protect against the development of OAC, although to be conclusive, data from randomised clinical trials are required.