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Minerva Urologica e Nefrologica 2021 Jan 13

DOI: 10.23736/S0393-2249.20.04076-X

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Association of statin use and oncological outcomes in patients with first diagnosis of T1 high grade non-muscle invasive urothelial bladder cancer: results from a multicentre study

Matteo FERRO 1, Michele MARCHIONI 2, Giuseppe LUCARELLI 3, Vartolomei M. DORIN 4, Francesco SORIA 5, Daniela TERRACCIANO 6, Francesco A. MISTRETTA 1, Stefano LUZZAGO 1, Carlo BUONERBA 7, Francesco CANTIELLO 8, Andrea MARI 9, Andrea MINERVINI 9, Alessandro VECCIA 10, Alessandro ANTONELLI 11, Gennaro MUSI 1, Rodolfo HURLE 12, Gian Maria BUSETTO 13, Francesco DEL GIUDICE 13, Benjamin I. CHUNG 14, Francesco BERARDINELLI 2, Sisto PERDONÀ 15, Paola DEL PRETE 16, Vincenzo MIRONE 17, Marco BORGHESI 18, Angelo PORRECA 19, Pierluigi BOVE 20, Riccardo AUTORINO 10, Nicolae CRISAN 21, Abdal R. ABU FARHAN 8, Michele BATTAGLIA 3, Pasquale DITONNO 3, Giorgio I. RUSSO 22, Matteo MUTO 23, Rocco DAMIANO 8, Matteo MANFREDI 24, Francesco PORPIGLIA 24, Ottavio DE COBELLI 1, Luigi SCHIPS 2

1 Division of Urology, European Institute of Oncology-IRCCS, Milan, Italy; 2 Department of Medical, Oral and Biotechnological Sciences, G. d'Annunzio University of Chieti, Urology Unit, SS. Annunziata Hospital, Chieti, Italy; 3 Department of Emergency and Organ Transplantation, Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy; 4 Department of Cell and Molecular Biology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureș, Romania; 5 Division of Urology, Department of Surgical Sciences, Torino School of Medicine, Torino, Italy; 6 Department of Translational Medical Sciences, University Federico II, Napoli, Italy; 7 CRTR Rare Tumors Reference Center, AOU Federico II, Napoli, Italy; 8 Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy; 9 Department of Urology, University of Florence, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy; 10 Division of Urology, Department of Surgery, VCU Health System, Richmond, VA; 11 Department of Urology, University of Verona, Verona, Italy; 12 Department of Urology, Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy; 13 Department of Urology, La Sapienza University of Rome, Rome, Italy; 14 Stanford University, School of Medicine, CA, USA; 15 Uro-Gynecological Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione G. Pascale-IRCCS, Naples, Italy; 16 Scientific Directorate, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione G. Pascale-IRCCS, Naples, Italy; 17 Department of Neurosciences, Sciences of Reproduction and Odontostomatology, Urology Unit, University Federico II, Napoli, Italy; 18 Department of Urology, University of Bologna, Bologna, Italy; 19 Department of Robotic Urologic Surgery, Abano Terme Hospital, Abano Terme, Padova, Italy; 20 Division of Urology, Department of Experimental Medicine and Surgery, Tor Vergata University of Rome, Rome, Italy; 21 Department of Urology, University of Medicine and Pharmacy Iuliu Haţieganu, Cluj-Napoca, Romania; 22 Department of Urology, University of Catania, Catania, Italy; 23 A.O.S.G. Moscati, U.O.C. Radioterapia, Avellino, Italy; 24 Division of Urology, Department of Oncology, School of Medicine, San Luigi Hopsital, University of Turin, Orbassano, Turin, Italy


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INTRODUCTION: We aimed to test the hypothesis that the immune-modulatory effect of statins may improve survival outcomes in patients with non-muscle invasive bladder cancer (NMIBC). We focused on a cohort of patients diagnosed with high risk NMIBC, that were treated with intravesical BCG immunotherapy.
PATIENTS AND METHODS: We included patients at first diagnosis of T1 high grade NMIBC after transurethral resection of bladder (TURB). All procedures were performed at 18 different tertiary institutions between January 2002 and December 2012. Univariable and multivariable models were used to test differences in terms of residual tumour, disease recurrence, disease progression and overall mortality (OM) rates.
RESULTS: Overall, 1510 patients with T1 high grade NMIBC at TURB were included in our analyses. Of these, 402 (26.6%) were statin users. At multivariable analysis, statin use was associated with a higher rates of high grade BC at re-TURB (OR: 1.37, 95%CI: 1.04-1.78; p=0.022), while at follow-up it was not independently associated with OM (HR: 0.71, 95%CI: 0.50-1.03; p=0.068) and disease progression rates (HR: 0.97, 95%CI: 0.79-1.19; p=0.753). Conversely, statin use has been shown to be independently associated with a lower risk of recurrence (HR:0.80, 95%CI: 0.67-0.95; p=0.009). The median recurrence-free survival was 47 (95%CI 40-49) months for those classified as non-statin users vs. 53 (95%CI 48-68) months in those classified as statin users.
CONCLUSIONS: Statin daily intake do not compromise oncological outcomes in high risk NMIBC patients treated with BCG. Moreover, statin may have a beneficial effect on recurrence rates in this cohort of patients.


KEY WORDS: Bladder cancer; Statin; BCG; Non-muscle invasive bladder cancer; Mortality

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