Systematic review with network meta-analysis: statins and risk of hepatocellular carcinoma

Objectives: Usage of statins is suggested to decrease the incidence of HCC. When it comes to different statin subtypes, the chemopreventive action remains controversial. We aim to compare the usage of different statins and reduction of HCC risk. Methods: We searched PubMed, Embase.com and Cochrane Library database up to August 10, 2015. Duplicated or overlapping reports were eliminated. We performed a traditional pair-wise meta-analysis and a Bayesian network meta-analysis to compare different treatments with a random-effects model. Results: We reviewed five observational studies enrolling a total of 87127 patients who received at least two different treatment strategies including rosuvastatin, atorvastatin, simvastatin, pravastatin, fluvastatin, cerivastatin, and lovastatin or observation alone. Direct comparisons showed that usage of atorvastatin (OR 0.63, 95% CI 0.45-0.89) and fluvastatin (OR 0.58, 95% CI 0.40-0.85) could significantly cut the risk of liver cancer. The difference of indirect comparisons between the included regimens is not statistically significant. However, usage of all types of statins, such as fluvastatin (RR 0.55, 95% CI 0.26-1.11), atorvastatin (RR 0.59, 95% CI 0.30-1.16), simvastatin (RR 0.69, 95% CI 0.38-1.25), cerivastatin (RR 0.71, 95% CI 0.19-2.70), pravastatin (RR 0.72, 95% CI 0.37-1.45), lovastatin (RR 0.81, 95% CI 0.34-1.96) and rosuvastatin (RR 0.92, 95% CI 0.44-1.80), appeared to be superior to observation alone. Notably, fluvastatin was hierarchically the best when compared with the six other statins. Conclusions: Our analyses indicate the superiority of usage of statins in reduction of liver cancer. Available evidence supports that fluvastatin is the most effective strategy for reducing HCC risk compared with other statin interventions.