Meta-Analysis
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Exp Med. Dec 20, 2024; 14(4): 98543
Published online Dec 20, 2024. doi: 10.5493/wjem.v14.i4.98543
Statins decrease the risk of hepatocellular carcinoma in metabolic dysfunction-associated steatotic liver disease: A systematic review and meta-analysis
Zahid Ijaz Tarar, Umer Farooq, Faisal Inayat, Sanket D Basida, Faisal Ibrahim, Mustafa Gandhi, Gul Nawaz, Arslan Afzal, Ammad J Chaudhary, Faisal Kamal, Ahmad H Ali, Yezaz A Ghouri
Zahid Ijaz Tarar, Mustafa Gandhi, Ahmad H Ali, Yezaz A Ghouri, Department of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, United States
Umer Farooq, Department of Gastroenterology and Hepatology, St. Louis University, St. Louis, MO 63104, United States
Faisal Inayat, Gul Nawaz, Department of Internal Medicine, Allama Iqbal Medical College, Lahore, Punjab 54550, Pakistan
Sanket D Basida, Department of Internal Medicine, University of Missouri, Columbia, MO 65212, United States
Faisal Ibrahim, Department of Internal Medicine, Wexham Park Hospital, Wexham SL24HL, Slough, United Kingdom
Arslan Afzal, Department of Hospital Medicine, ECU Health Medical Center, Greenville, NC 27834, United States
Ammad J Chaudhary, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI 48202, United States
Faisal Kamal, Department of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA 19107, United States
Author contributions: Tarar ZI, Farooq U, Inayat F, Basida SD, Ibrahim F, and Gandhi M concepted and designed the study, participated in the acquisition of data, interpretation of results, writing of the original draft, and critical revisions of the important intellectual content of the final manuscript; Nawaz G, Afzal A, Chaudhary AJ, Kamal F, and Ali AH contributed to the analysis and interpretation of results and drafting of the manuscript; Ghouri YA reviewed, revised, and improved the manuscript by suggesting pertinent modifications; all authors critically assessed, edited, and approved the final manuscript and are accountable for all aspects of the work.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2020 Checklist statement: The authors have read the PRISMA 2020 Checklist, and the manuscript was prepared and revised according to the PRISMA 2020 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Faisal Inayat, MBBS, Research Scientist, Department of Internal Medicine, Allama Iqbal Medical College, Allama Shabbir Ahmad Usmani Road, Faisal Town, Lahore, Punjab 54550, Pakistan. faisalinayat@hotmail.com
Received: June 29, 2024
Revised: October 2, 2024
Accepted: October 24, 2024
Published online: December 20, 2024
Processing time: 124 Days and 7.8 Hours
Abstract
BACKGROUND

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a leading cause of chronic liver disease with a significant risk of developing hepatocellular carcinoma (HCC). Recent clinical evidence indicates the potential benefits of statins in cancer chemoprevention and therapeutics. However, it is still unclear if these drugs can lower the specific risk of HCC among patients with MASLD.

AIM

To investigate the impact of statin use on the risk of HCC development in patients with MASLD.

METHODS

A systematic review and meta-analysis of all the studies was performed that measured the effect of statin use on HCC occurrence in patients with MASLD. The difference in HCC risk between statin users and non-users was calculated among MASLD patients. We also evaluated the risk difference between lipophilic versus hydrophilic statins and the effect of cumulative dose on HCC risk reduction.

RESULTS

A total of four studies consisting of 291684 patients were included. MASLD patients on statin therapy had a 60% lower pooled risk of developing HCC compared to the non-statin group [relative risk (RR) = 0.40, 95%CI: 0.31-0.53, I2 = 16.5%]. Patients taking lipophilic statins had a reduced risk of HCC (RR = 0.42, 95%CI: 0.28-0.64), whereas those on hydrophilic statins had not shown the risk reduction (RR = 0.57, 95%CI: 0.27-1.20). The higher (> 600) cumulative defined daily doses (cDDD) had a 70% reduced risk of HCC (RR = 0.30, 95%CI: 0.21-0.43). There was a 29% (RR = 0.71, 95%CI: 0.55-0.91) and 43% (RR = 0.57, 95%CI: 0.40-0.82) decreased risk in patients receiving 300-599 cDDD and 30-299 cDDD, respectively.

CONCLUSION

Statin use lowers the risk of HCC in patients with MASLD. The higher cDDD and lipophilicity of statins correlate with the HCC risk reduction.

Keywords: Metabolic dysfunction-associated steatotic liver disease; Hepatocellular carcinoma; Statins; Lipophilic statin; Hydrophilic statin; Meta-analysis

Core Tip: Current clinical evidence regarding the effect of statins on lowering the risk of hepatocellular carcinoma (HCC) among patients with metabolic dysfunction-associated steatotic liver disease (MASLD) is inconclusive. We performed a systematic review and meta-analysis of all the studies that evaluated the impact of statins on HCC occurrence in MASLD patients. The pooled data from four studies involving 291684 patients was included in the final analysis. Our findings show that statin use reduces the risk of HCC among patients with MASLD. The use of higher cumulative defined daily doses and lipophilic statins results in a significant reduction in HCC risk.