Statin use is associated with improved overall survival in patients with melanoma

Abstract

Melanoma remains a leading cause of cancer morbidity and mortality. Recent literature suggests that statin use may improve outcomes in patients with cancer. In order to determine whether statins may improve survival in melanoma patients, we analyzed data from the Veterans Health Administration Corporate Data Warehouse that contains individually identifiable clinical and demographic information from the 1990s to the present for over 19 million individual veterans. We found that melanoma patients who were taking a statin had better 5-year OS when compared with veterans not taking statins. This relationship remained significant in a multivariate model (hazard ratio, 0.38; 95% confidence interval, 0.34-0.43 for statin user vs. nonuser). Importantly, this effect was much larger than the effect of statins in the general population and was remained after controlling for the use of other medications (beta-blocker), implying that statins may have a direct effect on survival in melanoma patients.

Fig. 1

Five-year survival after diagnosis of malignant melanoma stratified by statin use. This figure describes the probability of survival during the first 5 years following malignant melanoma diagnosis. The cohort is stratified by statin use. Patients with at least 1 year (including the date of melanoma diagnosis) of statin use are represented by the dashed line. Patients with no statin exposure are represented by the solid line. Time (in months from the date of diagnosis) is shown along the x-axis, with survival probability on the y-axis. The lower table depicts the number of individuals at risk for each 6-month interval. P-value, computed by log-rank, reflects a statistically significant difference at the 0.0001 level in survival probability, based on statin exposure.

Fig. 2

Overall proportional hazard ratios (HRs) during the first year after diagnosis. Cox proportional hazards regression modeling, with backwards model selection by Akaike information criterion, was used to describe the influence of multiple covariates on 1 year survival following diagnosis of malignant melanoma. The most influential factors were metastatic disease at diagnosis (HR = 4.87) and statin use (HR = 0.38).