title: Impact of statin use on oncologic outcomes in patients with urothelial carcinoma of the bladder treated with radical cystectomy.
abstract: OBJECTIVE
  Statins are cholesterol lowering agents used to prevent cardiovascular disease. Evidence suggests a dichotomous effect of statins with cancer inhibiting and promoting properties. To our knowledge the effect of statins on the prognosis of muscle invasive urothelial carcinoma of the bladder remains uninvestigated to date. We tested the hypothesis that statin use impacts oncological outcomes in patients treated with radical cystectomy for urothelial carcinoma of the bladder.
  
  
  METHODS
  We retrospectively evaluated the records of 1,502 patients treated with radical cystectomy and pelvic lymphadenectomy without neoadjuvant therapy at a total of 4 institutions. Cox regression models were used to determine the association of statins with disease recurrence and cancer specific mortality.
  
  
  RESULTS
  A total of 642 patients (42.7%) were on statins. At a median followup of 34 months 509 patients (33.9%) experienced disease recurrence and 402 (26.8%) had died of urothelial carcinoma of the bladder. Statin users were older (p = 0.003), had a higher body mass index (median 32 vs 28 kg/m(2), p <0.001) and were more likely to have positive soft tissue surgical margins (9% vs 4%, p <0.001). On univariable Cox regression analysis statins, female gender, advanced age, higher body mass index, smoking status, tumor stage, tumor grade, soft tissue surgical margin status, lymphovascular invasion, lymph node metastasis and adjuvant chemotherapy were associated with disease recurrence (p ≤ 0.05) and cancer specific mortality (p ≤ 0.02). On multivariable Cox regression analysis statin use was not associated with either outcome.
  
  
  CONCLUSIONS
  Statin users were at higher risk for disease recurrence and cancer specific mortality on univariable but not multivariable analysis. These data do not support modification of statin use in patients with high risk urothelial carcinoma of the bladder who will be treated with radical cystectomy.
authors: Department of Urology and Division of Medical Oncology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York 10065, USA.
authors: Rodrigo Donalisio
authors: RD
authors: da Silva
authors: Evanguelos
authors: E
authors: Xylinas
authors: Luis
authors: L
authors: Kluth
authors: Joseph J
authors: JJ
authors: Crivelli
authors: James
authors: J
authors: Chrystal
authors: Daher
authors: D
authors: Chade
authors: Giuliano Betoni
authors: GB
authors: Guglielmetti
authors: Armin
authors: A
authors: Pycha
authors: Yair
authors: Y
authors: Lotan
authors: Pierre I
authors: PI
authors: Karakiewicz
authors: Maxine
authors: M
authors: Sun
authors: Harun
authors: H
authors: Fajkovic
authors: Marc
authors: M
authors: Zerbib
authors: Douglas S
authors: DS
authors: Scherr
authors: Shahrokh F
authors: SF
authors: Shariat
mesh_terms: D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D002295:Carcinoma, Transitional Cell / Q000401:mortality / Q000601:surgery*; D015653:Cystectomy / Q000379:methods; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000601:surgery*
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: BMI; CIS; LVI; RC; STSM; UCB; body mass index; carcinoma in situ; hydroxymethylglutaryl-CoA reductase inhibitors; lymphovascular invasion; mortality; neoplasm recurrence; positive soft tissue surgical margin; radical cystectomy; urinary bladder; urinary bladder neoplasms; urothelial carcinoma of bladder