title: Statin use and kidney cancer survival outcomes: A systematic review and meta-analysis.
abstract: BACKGROUND
  Statin use has been associated with improved survival outcomes in various malignancies. Randomized controlled trials are currently underway evaluating their utility as adjunctive cancer therapies. However, studies evaluating the association between statin use and outcomes in kidney cancer yield conflicting results.
  
  
  METHODS
  We searched MEDLINE and EMBASE to identify studies evaluating the association between statin use and kidney cancer survival outcomes. We evaluated risk of bias with the Newcastle-Ottawa Scale. We pooled hazard ratios for recurrence-free survival, progression-free survival, cancer-specific survival, and overall survival using random-effects models. We evaluated publication bias through Begg's and Egger's tests, and the trim and fill procedure.
  
  
  RESULTS
  We identified 12 studies meeting inclusion criteria and summarized data from 18,105 patients. No study was considered to be at high risk of bias. Statin use was not significantly associated with recurrence-free survival (pooled HR 0.97, 95% CI 0.89-1.06) or progression-free survival (pooled HR 0.92, 95% CI 0.51-1.65); however, statin use was associated with marked improvements in cancer-specific survival (pooled HR 0.67, 95% CI 0.47-0.94) and overall survival (pooled HR 0.74, 95% CI 0.63-0.88). There was no strong evidence of publication bias for any outcome.
  
  
  CONCLUSIONS
  Our results demonstrate that statin use among patients with kidney cancer is associated with significantly improved cancer-specific and overall survival. Further studies are needed to confirm the therapeutic role of statins in kidney cancer.
authors.affiliation: Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Canada.
authors.forename: Madhur
authors.initials: M
authors.lastname: Nayan
authors.affiliation: Division of Urology, London Health Sciences Centre, Western University, London, Canada.
authors.forename: Nahid
authors.initials: N
authors.lastname: Punjani
authors.affiliation: Department of Internal Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada.
authors.forename: David N
authors.initials: DN
authors.lastname: Juurlink
authors.affiliation: Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Canada.
authors.forename: Antonio
authors.initials: A
authors.lastname: Finelli
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada; Institute of Health Management, Policy and Evaluation, University of Toronto, Toronto, Canada; Schulich Heart Research Program, Sunnybrook Research Institute, Toronto, Canada.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Austin
authors.affiliation: Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Canada.
authors.forename: Girish S
authors.initials: GS
authors.lastname: Kulkarni
authors.affiliation: E.M. Uleryk Consulting, Mississauga, Ontario, Canada.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Uleryk
authors.affiliation: Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, Canada. Electronic address: rob.hamilton@uhn.ca.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Hamilton
mesh_terms: D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D007680:Kidney Neoplasms / Q000401:mortality*
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: HMG-CoA reductase inhibitor; Kidney neoplasms; Nephrectomy; Prognosis