Table 4.
Summary of the meta-analysis results by pooling all the datasets on associations of statin and the mortality or survival.
| Cancer Type | No of Studies | No of Total Participants | Random Effects (RR, 95%CI) |
P (Random) |
Fixed Effects (RR, 95%CI) |
P (Fixed) |
Largest Effect § (RR, 95%CI) |
D/N/I | Egger | I2 (P) † | 95% PI (Random) |
95% PI (Fixed) |
Concordant Direction | Evidence |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| All-cause mortality | ||||||||||||||
| Bladder cancer | 1 | 1117 | 1.14 (0.89–1.44) | 0.286 | 1.14 (0.89–1.44) | 0.286 | 1.14 (0.89–1.44) | 0/1/0 | - | - | NA | NA | No | Non-significant |
| Breast cancer | 20 | 160,806 | 0.65 (0.55–0.77) | <0.001 | 0.66 (0.62–0.70) | <0.001 | 0.54 (0.44–0.67) | 12/0/8 | 0.787 | 85.2 (<0.001) | 0.33–1.29 | 0.34–1.28 | Yes | Suggestive * |
| Colorectal cancer | 24 | 85,231 | 0.81 (0.75–0.88) | <0.001 | 0.82 (0.80–0.86) | <0.001 | 0.82 (0.74–0.90) | 15/8/1 | 0.444 | 68.1 (<0.001) | 0.60–1.10 | 0.61–1.11 | Yes | Suggestive * |
| Endocrine-related gynecological cancer | 9 | 5449 | 0.70 (0.58–0.83) | <0.001 | 0.71 (0.63–0.80) | <0.001 | 0.66 (0.55–0.80) | 4/5/0 | 0.250 | 33.3 (0.151) | 0.47–1.04 | 0.49–1.03 | Yes | Suggestive |
| Endometrial cancer | 4 | 3460 | 0.80 (0.62–1.03) | 0.083 | 0.84 (0.69–1.01) | 0.058 | 0.92 (0.70–1.20) | 1/3/0 | 0.046 | 36.1 (0.196) | 0.34–1.89 | 0.38–1.82 | Yes | Non-significant |
| Kidney cancer | 7 | 11,491 | 0.74 (0.63–0.88) | 0.001 | 0.78 (0.71–0.87) | <0.001 | 0.80 (0.66–0.98) | 4/3/0 | 0.057 | 51.8 (0.053) | 0.47–1.17 | 0.51–1.20 | Yes | Weak |
| Lymphoma | 3 | 782 | 1.15 (0.85–1.55) | 0.362 | 1.15 (0.85–1.55) | 0.362 | 1.23 (0.88–1.71) | 0/3/0 | 0.195 | 0.0 (0.602) | 0.16–8.24 | 0.16–8.24 | Yes | Non-significant |
| Ovarian cancer | 7 | 16,307 | 0.74 (0.63–0.87) | <0.001 | 0.79 (0.73–0.86) | <0.001 | 0.81 (0.72–0.90) | 4/3/0 | 0.067 | 0.0 (0.411) | 0.49–1.12 | 0.55–1.15 | Yes | Suggestive |
| Pancreatic cancer | 6 | 12,057 | 0.81 (0.69–0.95) | 0.009 | 0.92 (0.87–0.97) | 0.001 | 0.94 (0.89–1.01) | 3/3/0 | 0.008 | 81.1 (<0.001) | 0.52–1.26 | 0.62–1.36 | No | Weak |
| Prostate cancer | 21 | 95,128 | 0.73 (0.67–0.81) | <0.001 | 0.89 (0.88–0.91) | <0.001 | 0.79 (0.75–0.83) | 15/6/0 | 0.002 | 89.9 (<0.001) | 0.50–1.08 | 0.61–1.30 | No | Weak |
| Urothelial tract cancer | 5 | 9488 | 0.87 (0.75–1.00) | 0.049 | 0.87 (0.79–0.95) | 0.001 | 0.89 (0.71–1.12) | 2/3/0 | 0.917 | 52.8 (0.070) | 0.56–1.34 | 0.58–1.29 | No | Weak |
| Cancer-specific mortality | ||||||||||||||
| Bladder cancer | 2 | 2619 | 1.06 (0.87–1.29) | 0.559 | 1.06 (0.87–1.29) | 0.559 | 1.04 (0.84–1.28) | 0/2/0 | - | 0.0 (0.590) | NA | NA | Yes | Non-significant |
| Breast cancer | 28 | 424,694 | 0.71 (0.65–0.78) | <0.001 | 0.82 (0.80–0.84) | <0.001 | 0.83 (0.80–0.86) | 12/16/0 | 0.044 | 84.0 (<0.001) | 0.50–1.02 | 0.58–1.16 | Yes | Weak |
| Colorectal cancer | 13 | 118,996 | 0.81 (0.78–0.85) | <0.001 | 0.82 (0.79–0.85) | <0.001 | 0.77 (0.69–0.87) | 8/5/0 | 0.282 | 26.2 (0.180) | 0.72–0.92 | 0.74–0.90 | Yes | Convincing |
| Endocrine-related gynecological cancer | 4 | 1079 | 0.75 (0.55–1.01) | 0.057 | 0.72 (0.58–0.90) | 0.004 | 0.74 (0.54–1.02) | 1/3/0 | 0.357 | 35.1 (0.202) | 0.27–2.09 | 0.29–1.82 | Yes | Non-significant |
| Kidney cancer | 6 | 10,337 | 0.67 (0.48–0.94) | 0.022 | 0.81 (0.71–0.93) | 0.003 | 0.85 (0.72–1.01) | 3/3/0 | 0.120 | 66.6 (0.011) | 0.25–1.82 | 0.33–1.98 | No | Weak |
| Ovarian cancer | 3 | 27,690 | 0.87 (0.80–0.95) | 0.002 | 0.87 (0.80–0.95) | 0.002 | 0.93 (0.81–1.08) | 1/2/0 | 0.577 | 0.0 (0.411) | 0.50–1.54 | 0.50–1.54 | No | Weak |
| Prostate cancer | 15 | 101,378 | 0.66 (0.58–0.74) | <0.001 | 0.74 (0.71–0.78) | <0.001 | 0.74 (0.70–0.79) | 11/4/0 | 0.010 | 68.3 (<0.001) | 0.47–0.93 | 0.54–1.02 | Yes | Weak |
| Urothelial tract cancer | 4 | 6880 | 0.87 (0.66–1.14) | 0.307 | 0.87 (0.76–1.01) | 0.070 | 0.86 (0.72–1.03) | 1/3/0 | 0.901 | 61.8 (0.073) | 0.30–2.53 | 0.34–2.22 | Yes | Non-significant |
| Recurrence-free survival | ||||||||||||||
| Bladder cancer | 3 | 3571 | 1.06 (0.94–1.19) | 0.375 | 1.06 (0.94–1.19) | 0.375 | 1.04 (0.96–1.24) | 0/3/0 | 0.844 | 0.0 (0.950) | 0.47–2.36 | 0.47–2.36 | Yes | Non-significant |
| Breast cancer | 10 | 32,373 | 0.64 (0.52–0.79) | <0.001 | 0.69 (0.60–0.79) | <0.001 | 0.80 (0.64–1.00) | 6/4/0 | 0.093 | 44.0 (0.070) | 0.38–1.09 | 0.42–1.14 | Yes | Weak |
| Colorectal cancer | 2 | 1233 | 0.98 (0.36–2.70) | 0.975 | 1.12 (0.58–2.15) | 0.730 | 1.28 (0.64–2.54) | 0/2/0 | - | 26.1 (0.345) | NA | NA | Yes | Non-significant |
| Kidney cancer | 4 | 2197 | 0.97 (0.89–1.06) | 0.524 | 1.00 (0.99–1.01) | 0.899 | 1.09 (0.65–1.81) | 1/3/0 | 0.364 | 56.8 (0.074) | 0.70–1.36 | 0.36–1.31 | Yes | Non-significant |
| Prostate cancer | 13 | 21,185 | 0.90 (0.74–1.08) | 0.252 | 0.92 (0.84–1.00) | 0.057 | 0.99 (0.83–1.18) | 5/7/1 | 0.649 | 69.6 (<0.001) | 0.48–1.67 | 0.50–1.66 | Yes | Non-significant |
| Progression-free survival | ||||||||||||||
| Bladder cancer | 2 | 2069 | 0.87 (0.65–1.15) | 0.320 | 0.87 (0.65–1.15) | 0.320 | 0.77 (0.52–1.13) | 0/2/0 | 0.461 | 0.0 (0.370) | NA | NA | Yes | Non-significant |
| Endocrine-related gynecological cancer | 3 | 421 | 0.69 (0.46–1.02) | 0.066 | 0.68 (0.49–0.93) | 0.018 | 0.65 (0.39–1.07) | 1/2/0 | 0.439 | 33.6 (0.222) | 0.02–27.87 | 0.02–19.47 | Yes | Non-significant |
| Kidney cancer | 2 | 4965 | 0.92 (0.51–1.65) | 0.772 | 1.00 (0.82–1.23) | 0.996 | 0.67 (0.47–0.96) | 1/1/0 | - | 86.2 (0.007) | NA | NA | No | Non-significant |
| Prostate cancer | 5 | 6032 | 0.84 (0.62–1.14) | 0.260 | 0.87 (0.71–1.05) | 0.148 | 1.10 (0.78–1.56) | 2/3/0 | 0.607 | 52 (0.080) | 0.34–2.10 | 0.38–2.00 | Yes | Non-significant |
| Disease-free survival | ||||||||||||||
| Colorectal cancer | 2 | 1,233 | 1.13 (0.78–1.62) | 0.514 | 1.13 (0.78–1.62) | 0.514 | 1.07 (0.68–1.67) | 0/2/0 | - | 0.0 (0.691) | NA | NA | Yes | Non-significant |
D/N/I, Decreasing risk/No difference/Increasing risk; RR, Risk ratio; CI, Confidence interval; PI, Prediction. § Risk ratio (95% Confidence interval) of the largest study in each meta-analysis. † I2 metric of inconsistency (95% confidence interval of I2) and P-value of the Cochran Q test for evaluation of heterogeneity. * Suggestive or convincing level of evidence due to the greater number of studies that decrease risk in which a high heterogeneity is due to differences in the effect size of the association.