# Impact of statin use on survival and adverse events in patients with cancer receiving radiotherapy: a systematic review and meta-analysis

## TL;DR

This study finds that statin use during cancer radiotherapy does not significantly affect overall survival but may influence adverse events and outcomes depending on cancer type.

## Contribution

The study provides a systematic review and meta-analysis of statin effects on cancer radiotherapy outcomes, revealing cancer-specific survival and adverse event associations.

## Key findings

- Statin use was not associated with significant differences in overall survival rates.
- Statin users had higher risks of certain adverse events like cardiac events and mucositis, but lower risks of others like stroke and rectal toxicity.
- Survival outcomes varied significantly by cancer type, with both improved and reduced survival observed in specific cancers.

## Abstract

Given limited and conflicting data, this systematic review and meta-analysis investigate the impacts of statin use on survival outcomes and adverse events in patients with cancer receiving radiotherapy.

A comprehensive search of MEDLINE, EMBASE, Web of Science, Scopus, and PubMed (January 2000 to June 2024) included studies on adults (≥ 18 years) with histologically confirmed cancer receiving oral statins during radiotherapy. Overall survival (OS) rates and radiotherapy-related adverse effects were compared between statin users and non-users using odds ratios (ORs) and 95% confidence intervals (95%CIs). Meta-regression explored the effects of cancer type and statin intensity on OS rates, reported as coefficients (β) and 95%CI.

Of 21 studies (19 cohort studies and two randomized trials), OS rates did not significantly differ between statin users and non-users (OR: 1.29; 95%CI: 0.99, 1.69) or by statin intensity (β: 0.20; 95%CI: -1.22, 1.62; p = 0.60), but significantly by cancer types (β: -0.29; 95%CI: -0.45, -0.13; p < 0.01). Statin use was associated with improved survival in oesophageal squamous cell carcinoma (SCC), head and neck SCC, glioblastoma, and prostate cancer, but with reduced survival in non-small cell lung cancer (NSCLC) and brain metastases. Statin users had a higher risk of major adverse cardiac events (OR: 2.22; 95%CI: 1.38, 3.59) in NSCLC and ≥ grade 2 mucositis (OR: 26.00; 95%CI: 4.09, 165.10) in head and neck squamous cell carcinoma but lower risks of ischemic stroke (OR: 0.80; 95%CI: 0.67, 0.95) in nasopharyngeal carcinoma and rectal toxicity (OR: 0.45; 95%CI: 0.23, 0.88) in prostate cancer.

Survival outcomes did not significantly differ by statin use or intensity but varied by cancer type. Statin users had lower risks of ischemic stroke and rectal toxicity. Further studies are needed to control for confounding biases.

PROSPERO registration CRD42023487336.

The online version contains supplementary material available at 10.1186/s12885-025-15038-3.