title: Statin use and survival after colorectal cancer: the importance of comprehensive confounder adjustment.
abstract: BACKGROUND
  Statins have been associated with moderate reductions in mortality among colorectal cancer (CRC) patients, but these studies lacked adjustment for some potentially relevant factors associated with statin use. We aimed to provide more detailed results on this association from a population-based patient cohort study.
  
  
  METHODS
  Use of statins and other risk or protective factors were assessed in standardized interviews with 2697 patients from southern Germany with a diagnosis of incident CRC between 2003 and 2009 (Darmkrebs: Chancen der Verhütung durch Screening [DACHS] study). Follow-up included assessment of therapy details, recurrence, vital status, and cause of death. Information about molecular pathological subtypes of CRC was available for 1209 patients. Cox proportional hazard regression models were used to estimate adjusted hazard ratios (HRs) and their 95% confidence intervals (CIs). All statistical tests were two-sided.
  
  
  RESULTS
  Patients were age 68 years on average, 412 used statins (15%), and 769 died during follow-up (29%). After a median follow-up time of 3.4 years, use of statins was not associated with overall (HR = 1.10, 95% CI = 0.85 to 1.41), CRC-specific (HR = 1.11, 95% CI = 0.82 to 1.50), or recurrence-free survival (HR = 0.90, 95% CI = 0.63 to 1.27). Analyses in relevant subgroups also showed no association of statin use with overall and CRC-specific survival, and no associations were observed after stratifying for major pathological subtypes. Among stage I and II patients, statin use was associated with better recurrence-free but not with better CRC-specific survival.
  
  
  CONCLUSIONS
  Statin use was not associated with reduced mortality among CRC patients. Effects reported in previous studies might reflect incomplete control for stage at diagnosis and other factors associated with the use of statins.
authors.affiliation: Division of Clinical Epidemiology and Aging Research (MH, LJ, HBr), Division of Cancer Epidemiology (AR, JCC), and Unit of Molecular Tumor Pathology (WR), German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Pathology (CT, WR) and Department of Applied Tumor Biology (MK), Institute of Pathology, Heidelberg University Hospital, Germany; Institute of Pathology, Charité University Medicine, Berlin, Germany (HBl); German Cancer Consortium (DKTK), Heidelberg, Germany (HBr). m.hoffmeister@dkfz.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Hoffmeister
authors.affiliation: Division of Clinical Epidemiology and Aging Research (MH, LJ, HBr), Division of Cancer Epidemiology (AR, JCC), and Unit of Molecular Tumor Pathology (WR), German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Pathology (CT, WR) and Department of Applied Tumor Biology (MK), Institute of Pathology, Heidelberg University Hospital, Germany; Institute of Pathology, Charité University Medicine, Berlin, Germany (HBl); German Cancer Consortium (DKTK), Heidelberg, Germany (HBr).
authors.forename: Lina
authors.initials: L
authors.lastname: Jansen
authors.affiliation: Division of Clinical Epidemiology and Aging Research (MH, LJ, HBr), Division of Cancer Epidemiology (AR, JCC), and Unit of Molecular Tumor Pathology (WR), German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Pathology (CT, WR) and Department of Applied Tumor Biology (MK), Institute of Pathology, Heidelberg University Hospital, Germany; Institute of Pathology, Charité University Medicine, Berlin, Germany (HBl); German Cancer Consortium (DKTK), Heidelberg, Germany (HBr).
authors.forename: Anja
authors.initials: A
authors.lastname: Rudolph
authors.affiliation: Division of Clinical Epidemiology and Aging Research (MH, LJ, HBr), Division of Cancer Epidemiology (AR, JCC), and Unit of Molecular Tumor Pathology (WR), German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Pathology (CT, WR) and Department of Applied Tumor Biology (MK), Institute of Pathology, Heidelberg University Hospital, Germany; Institute of Pathology, Charité University Medicine, Berlin, Germany (HBl); German Cancer Consortium (DKTK), Heidelberg, Germany (HBr).
authors.forename: Csaba
authors.initials: C
authors.lastname: Toth
authors.affiliation: Division of Clinical Epidemiology and Aging Research (MH, LJ, HBr), Division of Cancer Epidemiology (AR, JCC), and Unit of Molecular Tumor Pathology (WR), German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Pathology (CT, WR) and Department of Applied Tumor Biology (MK), Institute of Pathology, Heidelberg University Hospital, Germany; Institute of Pathology, Charité University Medicine, Berlin, Germany (HBl); German Cancer Consortium (DKTK), Heidelberg, Germany (HBr).
authors.forename: Matthias
authors.initials: M
authors.lastname: Kloor
authors.affiliation: Division of Clinical Epidemiology and Aging Research (MH, LJ, HBr), Division of Cancer Epidemiology (AR, JCC), and Unit of Molecular Tumor Pathology (WR), German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Pathology (CT, WR) and Department of Applied Tumor Biology (MK), Institute of Pathology, Heidelberg University Hospital, Germany; Institute of Pathology, Charité University Medicine, Berlin, Germany (HBl); German Cancer Consortium (DKTK), Heidelberg, Germany (HBr).
authors.forename: Wilfried
authors.initials: W
authors.lastname: Roth
authors.affiliation: Division of Clinical Epidemiology and Aging Research (MH, LJ, HBr), Division of Cancer Epidemiology (AR, JCC), and Unit of Molecular Tumor Pathology (WR), German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Pathology (CT, WR) and Department of Applied Tumor Biology (MK), Institute of Pathology, Heidelberg University Hospital, Germany; Institute of Pathology, Charité University Medicine, Berlin, Germany (HBl); German Cancer Consortium (DKTK), Heidelberg, Germany (HBr).
authors.forename: Hendrik
authors.initials: H
authors.lastname: Bläker
authors.affiliation: Division of Clinical Epidemiology and Aging Research (MH, LJ, HBr), Division of Cancer Epidemiology (AR, JCC), and Unit of Molecular Tumor Pathology (WR), German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Pathology (CT, WR) and Department of Applied Tumor Biology (MK), Institute of Pathology, Heidelberg University Hospital, Germany; Institute of Pathology, Charité University Medicine, Berlin, Germany (HBl); German Cancer Consortium (DKTK), Heidelberg, Germany (HBr).
authors.forename: Jenny
authors.initials: J
authors.lastname: Chang-Claude
authors.affiliation: Division of Clinical Epidemiology and Aging Research (MH, LJ, HBr), Division of Cancer Epidemiology (AR, JCC), and Unit of Molecular Tumor Pathology (WR), German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Pathology (CT, WR) and Department of Applied Tumor Biology (MK), Institute of Pathology, Heidelberg University Hospital, Germany; Institute of Pathology, Charité University Medicine, Berlin, Germany (HBl); German Cancer Consortium (DKTK), Heidelberg, Germany (HBr).
authors.forename: Hermann
authors.initials: H
authors.lastname: Brenner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology; D015986:Confounding Factors, Epidemiologic; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000401:mortality*; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016019:Survival Analysis
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors