ORIGINAL ARTICLE   Free access

Minerva Urology and Nephrology 2021 December;73(6):796-802

DOI: 10.23736/S2724-6051.20.04076-X

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

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 multicenter study

Matteo FERRO ¹ ✉, Michele MARCHIONI ², Giuseppe LUCARELLI ³, Mihai D. VARTOLOMEI 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 M. 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, IRCCS European Institute of Oncology, Milan, Italy; ² Unit of Urology, Department of Medical, Oral and Biotechnological Sciences, SS. Annunziata Hospital, G. D’Annunzio University, Chieti, Italy; ³ Section of Urology, Unit of Andrology and Kidney Transplantation, Department of Emergency and Organ Transplantation, 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 School of Medicine, Division of Urology, Department of Surgical Sciences, Turin, Italy; ⁶ Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy; ⁷ CRTR Rare Tumors Reference Center, University of Naples Federico II, Naples, Italy; ⁸ Department of Urology, Magna Graecia University, Catanzaro, Italy; ⁹ Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Urology, University of Florence, Careggi Hospital, Florence, Italy; ¹⁰ Division of Urology, Department of Surgery, VCU Health System, Richmond, VA, USA; ¹¹ Department of Urology, University of Verona, Verona, Italy; ¹² IRCCS Humanitas Clinic, Rozzano, Milan, Italy; ¹³ Department of Urology, Sapienza University, Rome, Italy; ¹⁴ School of Medicine, Stanford University, Stanford, CA, USA; ¹⁵ Department Uro-Gynecology, IRCCS G. Pascale Foundation, National Institute for the Study and Treatment of Cancer, Naples, Italy; ¹⁶ Scientific Directorate, IRCCS G. Pascale Foundation, National Institute for the Study and Treatment of Cancer, Naples, Italy; ¹⁷ Unit of Urology, Department of Neurosciences, Sciences of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy; ¹⁸ Department of Urology, University of Bologna, Bologna, Italy; ¹⁹ Department of Robotic Urologic Surgery, Abano Terme Hospital, Abano Terme, Padua, Italy; ²⁰ Division of Urology, Department of Experimental Medicine and Surgery, Tor Vergata University, 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 Unit of Radiotherapy, Moscati University Hospital, Avellino, Italy; ²⁴ School of Medicine, Division of Urology, Department of Oncology, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy

BACKGROUND: 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.
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 tumor, 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 rate 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: Urinary bladder neoplasms; Urinary Bladder; Therapeutics; Mortality