title: The association of statin therapy with clinicopathologic outcomes and survival among patients with localized renal cell carcinoma undergoing nephrectomy.
abstract: OBJECTIVE
  Although statins have been found to induce apoptosis and demonstrate antimetastases activity both in vitro and in vivo for renal cell carcinoma (RCC), clinical evidence of a role for these medications is limited. We evaluated the association of statin therapy with outcomes among patients with surgically treated localized RCC.
  
  
  METHODS
  We reviewed 2,357 patients who underwent nephrectomy between 1995 and 2009 for pNx/0, M0 RCC. Of these, 630 (27%) were taking statins within 3 months of surgery. Progression-free survival, cancer-specific survival, and overall survival were estimated using the Kaplan-Meier method. The associations of statin use with clinicopathologic outcomes were evaluated with multivariable logistic and proportional hazards regression models.
  
  
  RESULTS
  Statin therapy at the time of nephrectomy was not significantly associated with the risks of locally advanced (pT3-4) pathologic tumor stage (odds ratio = 0.96; P = 0.80) or high (3-4) tumor grade (odds ratio = 1.11; P = 0.30). Median postoperative follow-up was 7.8 years. Compared with patients not on statin therapy, patients taking statins at surgery had similar 10-year progression-free survival (80% vs. 79%; P = 0.56), cancer-specific survival (85% vs. 84%; P = 0.71), and overall survival (59% vs. 64%; P = 0.11). On multivariable analysis, statin use was not significantly associated with the risks of disease progression (hazard ratio [HR] = 1.22; P = 0.10), death from RCC (HR = 1.02; P = 0.90), or all-cause mortality (HR = 0.84; P = 0.05).
  
  
  CONCLUSIONS
  We found no independent association between preoperative statin therapy and oncologic outcomes among patients with surgically treated localized RCC. Our data thus do not support an anticancer role for statin therapy in this setting.
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN.
authors.forename: Boyd R
authors.initials: BR
authors.lastname: Viers
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN.
authors.forename: R
authors.initials: R
authors.lastname: Houston Thompson
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN.
authors.forename: Sarah P
authors.initials: SP
authors.lastname: Psutka
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Lohse
authors.affiliation: Department of Anatomic Pathology, Mayo Clinic, Rochester, MN.
authors.forename: John C
authors.initials: JC
authors.lastname: Cheville
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN.
authors.forename: Bradley C
authors.initials: BC
authors.lastname: Leibovich
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN.
authors.forename: Matthew K
authors.initials: MK
authors.lastname: Tollefson
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN. Electronic address: boorjian.stephen@mayo.edu.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Boorjian
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000188:drug therapy; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: HGM-CoA reductase inhibitor; Nephrectomy; Renal cell carcinoma; Statin; localized