Statin Use Ameliorates Survival in Oral Squamous Cell Carcinoma-Data from a Population-Based Cohort Study Applying Propensity Score Matching

Abstract

The anti-cancer properties of statins have attracted much attention recently, but little is known about the prognostic role of statins in oral squamous cell carcinoma (OSCC). In a retrospective approach, we analyzed a population-based cohort of 602 OSCC patients with primary curative tumor resection to negative margins and concomitant neck dissection between 2005-2017. Long-term medication with statins was correlated with overall survival (OAS) as well as recurrence-free survival (RFS) using uni- and multivariable Cox regression. Additionally, propensity score matching was applied to adjust for confounders. Statin use was present in 96 patients (15.9%) at a median age of 65.7 years. Statin treatment correlated with ameliorated survival in multivariable Cox regression in the complete cohort (OAS: HR 0.664; 95% CI 0.467-0.945, p = 0.023; RFS: HR 0.662; 95% CI 0.476-0.920, p = 0.014) as well as matched-pair cohort of OSCC patients (OAS: HR 0.691; 95% CI 0.479-0.997, p = 0.048; RFS: HR 0.694; 95% CI 0.493-0.976, p = 0.036) when compared to patients not taking statins at time of diagnosis. These findings were even more pronounced by sub-group analysis in the matched-pair cohort (age < 70 years). These data indicate that statin use might ameliorate the oncological outcome in primarily resected OSCC patients, but prospective clinical trials are highly recommended.

Keywords: CVD; HNSCC; OSCC; PSM; cardiovascular disease; hydroxymethylglutaryl CoA reductase inhibitor; oral squamous cell carcinoma; propensity score matching; statin; survival.

Figure 1

Survival in a matched-pair cohort of OSCC patients with age at diagnosis <50 years (n = 359) comparing patients taking statins to those patients without statin treatment: (A): Kaplan–Meier analysis for OAS (p = 0.099); (B): Kaplan–Meier analysis for RFS (p = 0.074).

Figure 2

Survival in a matched-pair cohort of OSCC patients with age at diagnosis <70 years (n = 246) comparing patients taking statins at the time of diagnosis compared to those patients without statin treatment: (A): Kaplan–Meier analysis for OAS (p = 0.014); (B): Kaplan–Meier analysis for RFS (p = 0.032).