The Effects of Statins in Patients with Endometrial Carcinoma on Cancer Progression, Recurrence, and Survival

Objective: Our pilot study was to evaluate the effects of statins on progression free survival (PFS) and 5-year, 10-year, and overall survival (OS) in patients with endometrial cancer (EC). Methods: We conducted a retrospective cohort study of 197 patients diagnosed with EC between 01/01/2008 – 10/31/2023 at a single academic institution in central Missouri. All stages were included. Patients were excluded from the study if they had inadequate records of treatment or follow up or received care outside of the university clinics. Cancer history, medication use, and patient demographics were collected from the electronic medical records and coded into REDCap using standardized operating procedures developed by the research team. Survival analysis was conducted using log rank and Kaplan-Meier estimates as well as Cox modeling for multivariate analysis. P-value <0.05 was used to determine statistical significance. Results: A total of 197 patients met inclusion criteria with a mean age of 68 and mean BMI of 39.6. Among the included patients, 98 (49.7%) had grade 1 EC while 69 (35.0%) and 30 (15.2%) had grade 2 and 3 EC, respectively. There were no differences in age or BMI in patients using statin therapy versus those not using statin therapy. Of 197 patients included in the study, 89 (45.2%) had a history of statin use and 108 (54.8%) did not have a history of statin use. The mean overall survival of patients with statin use was approximately 115 months vs 104 months for patients without a history of statin use (p= 0.4403). Further data analysis of our clinical cohort revealed a longer PFS in patients who have used a statin (66.2 months) compared to the group without statin use (53.7 months, p = 0.9258). Five year survival rate was 46.6 months for statin users and 50.2 months for those with no use (p=0.5920) while the 10-year survival rate was noted to be 86.9 months vs 84.3 months, respectively (p=0.3087). Multivariate analysis of OS and PFS was only significantly affected by cancer grade. The current pilot study suggests that OS and PFS may be longer among statin users when compared to patients who have not used a statin. Both differences lack statistical significance in our cohort; however, given the magnitude of difference in PFS and OS in our study, there is a suggestion of possible clinical impact. Conclusions: Further results from our lab’s study of statin treated murine models showed reduced rates of distant metastasis and longer PFS, which supports the results of our clinical cohort. However, it is important to note that we did not see this trend amongst statin users within our 5-year survival model indicating that statin impact on cancer progression may have a time-dependent component. Therefore, we plan to expand our exploration of this data and our objectives to include a new multicenter consortium of patient records across several states. We suspect expanding our cohort may further reveal a statistically significant interplay between the cancer progressing effects of poor diet and lipid rich environments in the setting of cancer suppressing effects of statins.