title: Statin therapy is associated with improved survival in patients with non-serous-papillary epithelial ovarian cancer: a retrospective cohort analysis.
abstract: OBJECTIVE
  To determine whether statin use is associated with improved epithelial ovarian cancer (OvCa) survival.
  
  
  METHODS
  This is a single-institution retrospective cohort review of patients treated for OvCa between 1992 and 2013. Inclusion criteria were International Federation of Gynecology and Obstetrics (FIGO) stage I-IV OvCa. The primary exposures analyzed were hyperlipidemia and statin use. The primary outcomes were progression-free survival (PFS) and disease-specific survival (DSS).
  
  
  RESULTS
  442 patients met inclusion criteria. The cohort was divided into three groups: patients with hyperlipidemia who used statins (n = 68), patients with hyperlipidemia who did not use statins (n = 28), and patients without hyperlipidemia (n = 346). OvCa outcomes were evaluated. When we analyzed the entire cohort, we found no significant differences in PFS or DSS among the groups. The median PFS for hyperlipidemics using statins, hyperlipidemics not using statins, and non-hyperlipidemics was 21.7, 13.6, and 14.7 months, respectively (p = 0.69). Median DSS for hyperlipidemics using statins, hyperlipidemics not using statins, and non-hyperlipidemics was 44.2, 75.7, and 41.5 months, respectively (p = 0.43). These findings did not change after controlling for confounders. However, a secondary analysis revealed that, among patients with non-serous-papillary subtypes of OvCa, statin use was associated with a decrease in hazards of both disease recurrence (adjusted HR = 0.23, p = 0.02) and disease-specific death (adjusted HR = 0.23, p = 0.04). To augment the findings in the retrospective cohort, the histology-specific effects of statins were also evaluated in vitro using proliferation assays. Here, statin treatment of cell lines resulted in a variable level of cytotoxicity.
  
  
  CONCLUSIONS
  Statin use among patients with non-serous-papillary OvCa was associated with improvement in both PFS and DSS.
authors.affiliation: Department of Obstetrics & Gynecology/Section of Gynecologic Oncology - Center for Integrative Science, University of Chicago, Chicago, Illinois, United States of America.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Habis
authors.affiliation: Department of Health Studies, University of Chicago, Chicago, Illinois, United States of America.
authors.forename: Kristen
authors.initials: K
authors.lastname: Wroblewski
authors.affiliation: Department of Pharmaceutical Sciences, Chicago State University, Chicago, Illinois, United States of America.
authors.forename: Michael
authors.initials: M
authors.lastname: Bradaric
authors.affiliation: Department of Obstetrics & Gynecology/Section of Gynecologic Oncology - Center for Integrative Science, University of Chicago, Chicago, Illinois, United States of America.
authors.forename: Nadia
authors.initials: N
authors.lastname: Ismail
authors.affiliation: Department of Obstetrics & Gynecology/Section of Gynecologic Oncology - Center for Integrative Science, University of Chicago, Chicago, Illinois, United States of America.
authors.forename: S Diane
authors.initials: SD
authors.lastname: Yamada
authors.affiliation: Department of Obstetrics & Gynecology/Section of Gynecologic Oncology - Center for Integrative Science, University of Chicago, Chicago, Illinois, United States of America.
authors.forename: Lacey
authors.initials: L
authors.lastname: Litchfield
authors.affiliation: Department of Obstetrics & Gynecology/Section of Gynecologic Oncology - Center for Integrative Science, University of Chicago, Chicago, Illinois, United States of America.
authors.forename: Ernst
authors.initials: E
authors.lastname: Lengyel
authors.affiliation: Department of Obstetrics & Gynecology/Section of Gynecologic Oncology - Center for Integrative Science, University of Chicago, Chicago, Illinois, United States of America.
authors.forename: Iris L
authors.initials: IL
authors.lastname: Romero
mesh_terms: D049109:Cell Proliferation / Q000187:drug effects; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006949:Hyperlipidemias / Q000150:complications* / Q000188:drug therapy*; D016013:Likelihood Functions; D008148:Lovastatin / Q000494:pharmacology; D010051:Ovarian Neoplasms / Q000150:complications* / Q000188:drug therapy*; D012189:Retrospective Studies
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008148:Lovastatin