| Summary: | 碩士 === 國立臺灣大學 === 公共衛生碩士學位學程 === 101 === Abstract
Background: Chronic infection with hepatitis B virus (HBV) often causes chronic inflammation of the liver with an increased incidence of hepatocellular carcinoma. HBV-infected individuals also may be at increased incidence of non-liver cancers. Taking a statin or metformin may decrease inflammation and infiltration, which may, as a result, reduce the risk of liver cancer or other major cancers in patients with HBV infection. The purpose of this study was to evaluate the hypothesis that a statin and metformin could reduce the incidence of liver cancer (HBV) or non-liver cancers in patients with hepatitis B virus.
Method: Using the Taiwan Longitudinal Health Insurance Database 2000 to 2008, this cohort study comprised patients with a recorded diagnosis of HBV (N=71,847) between January 1, 2000 and December 31, 2008. Each patient was followed until the end of 2008. The occurrence of HCC or a non-liver cancer was evaluated in patients who either were or were not taking a statin or metformin. Cox proportional hazard regressions were used to evaluate the cancer incidence after adjusting for known confounding factors.
Results: A total of 71,824 HBV-infected patients comprised the study cohort. Our study showed that either metformin or statin use was associated with a reduction in the incidence of cancer. This was most prominent in patients taking both a statin and metformin. The adjusted HRs for patients using only a statin were 0.52 (95% CI, 0.48 to 0.57) for all cancers, 0.28 (95% CI, 0.23 to 0.35) for liver cancers, and 0.63 (95% CI, 0.57 to 0.70) for non-liver cancers. Patients taking only metformin had risk-adjusted HRs of 0.82 (95% CI, 0.75 to 0.90) for all cancers, 0.97 (95% CI, 0.84 to 1.14) for liver cancers, and 0.75 (95% CI, 0.67 to 0.84) for non-liver cancers. A dose-dependent effect of statin use for chemoprevention was observed for all cancers, including both liver cancer and non-liver cancers. A dose-dependent effect of metformin was also seen in liver cancers and non-liver cancers without stratification into different cDDDs of statin use.
Conclusion: This population-based cohort study investigated the protective effect of a statin and metformin against cancer events in the patients with HBV infection. Our study demonstrated that either a statin or metformin were independent chemo-preventive agents with a dose-response effect in reducing the incidence of cancer with a dose-response effect of the agents and an additive or synergistic effect of combining a statin and metformin use in reducing the incidence of many cancers.
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