title: Statin use is associated with improved survival in patients undergoing surgery for renal cell carcinoma.
abstract: OBJECTIVE
  To determine whether statin use at time of surgery is associated with survival following nephrectomy or partial nephrectomy for renal cell carcinoma (RCC). Statins are thought to exhibit a protective effect on cancer incidence and possibly cancer survival in a number of malignancies. To date, no studies have shown an independent association between statin use and mortality in RCC.
  
  
  METHODS
  A retrospective cohort study of 916 patients who underwent radical or partial nephrectomy for RCC from 2000 to 2010 at a single institution was performed. Primary outcomes were overall (OS) and disease-specific survival (DSS). Univariable survival analyses were performed using the Kaplan-Meier and the log-rank methods. Multivariable analysis was performed using a Cox proportional hazards model. The predictive discrimination of the models was assessed using the Harrell c-index.
  
  
  RESULTS
  The median follow-up of the entire cohort was 42.5 months. The 3-year OS estimate was 83.1% (95% CI: 77.6%-87.3%) for statin users and 77.3% (95% CI: 73.7%-80.6%) for nonstatin users (P = 0.53). The 3-year DSS was 90.9% (95% CI: 86.3%-94.0%) for statin users and 83.5% (95% CI: 80.1%-86.3%) for nonstatin users (P = 0.015). After controlling for age, American Society of Anesthesiology class, pT category, pN category, metastatic status, preoperative anemia and corrected hypercalcemia, and blood type, statin use at time of surgery was independently associated with improved OS (hazard ratio = 0.62; 95% CI: 0.43-0.90; P = 0.011) and DSS (hazard ratio = 0.48; 95% CI: 0.28-0.83; P = 0.009). The multivariable model for DSS had excellent predictive discrimination with a c-index of 0.91.
  
  
  CONCLUSIONS
  These data suggest that statin usage at time of surgery is independently associated with improved OS and DSS in patients undergoing surgery for RCC.
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN. Electronic address: kaffenbs@mskcc.org.
authors.forename: Samuel D
authors.initials: SD
authors.lastname: Kaffenberger
authors.affiliation: Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Opal
authors.initials: O
authors.lastname: Lin-Tsai
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN; Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Stratton
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN; Department of Urology, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Todd M
authors.initials: TM
authors.lastname: Morgan
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN; Center for Surgical Quality and Outcomes Research, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Barocas
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Sam S
authors.initials: SS
authors.lastname: Chang
authors.affiliation: Department of Urology, University of Oklahoma College of Medicine, Oklahoma City, OK.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Cookson
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: S Duke
authors.initials: SD
authors.lastname: Herrell
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Smith
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Peter E
authors.initials: PE
authors.lastname: Clark
mesh_terms: D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D007680:Kidney Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D013714:Tennessee / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Nephrectomy; Partial nephrectomy; Renal cell carcinoma; Statins