Abstract

Objective: There is increasing evidence that statin use decreases the incidence and improves survival of gynecologic malignancies, but the role in endometrial cancer (EC) has not been defined. Our primary aim is to investigate statin use and its association with high intermediate risk (HIR) features in early stage EC. We hypothesize those women who develop early stage EC while taking statins have less aggressive features on pathology at the time of hysterectomy. Our secondary aim is to determine if concurrent use of other medications demonstrating anti-cancer effects; metformin, NSAIDs and bisphosphonates may reduce the risk of development of HIR early stage EC. Study
Design: Four-hundred patients with stage I EC who underwent hysterectomy at a single institution from 2008-2013 were reviewed to determine presence of any HIR features. lymph vascular space invasion, Grade 2 or 3 and greater than 50% my invasion. Associations between statin use and presence of any HIR features at the time of hysterectomy were examined using multivariate logistic regression adjusting for age, BMI, parity, diabetes, and hypertension. Baseline metformin, NSAIDs, and bisphosphonate use was also included in the analysis.
Results: Of the 400 patients, 75 (18.8%) had at least one high intermediate risk feature, and 124 (28.5%) were taking a statin at the time of diagnosis. Thirty one percent of our patients had BMI >30, 74% of our patients were younger than 70, 21% had a diagnosis of diabetes, 36% of hypertension. Statin use was associated with increased high risk features (OR 2.4, 95% CI 1.3-4.3) at the time of hysterectomy. There was a non-significant higher percentage of patients who recurred in the Statin users 10.5% (12/114) v 6.3% (18/286) in non-users. (p=0.15).
Conclusion: Our findings suggest that statin use confers a two times greater risk of having high risk features at the time of hysterectomy for early stage endometrial cancer. Statin use may prevent early stage low risk endometrial cancer, leading to an increased number of patients with HIR features in our statin user population.

Keywords: Endometrial cancer; Gynecologic cancer; Hypertension; Metabolic-syndrome