Statin use and oncologic outcomes following neoadjuvant therapy for esophageal cancer

Background: Statins, widely prescribed for hypercholesterolemia, have demonstrated potential anti-neoplastic properties in preclinical studies. Despite growing interest in their oncologic effects, the role of statin therapy within curative treatment of esophageal cancer remains unexplored. This study aimed to evaluate the impact of statin use on pathologic complete response (pCR) rate, disease-free survival (DFS), and overall survival (OS) in patients undergoing neoadjuvant chemo(radio)therapy followed by esophagectomy. Methods: All consecutive patients with esophageal or gastroesophageal junction cancer who underwent esophagectomy following neoadjuvant therapy between March 1994 and September 2013 were retrospectively analyzed using a prospectively maintained database. Baseline demographic and clinical variables were compared between statin users and non-users. Results: A total of 463 patients were included, of whom 90 (19.4%) were statin users at diagnosis. Neoadjuvant chemotherapy (CT) was administered in 88 patients (19%) and chemoradiotherapy (CRT) in 375 patients (81%). pCR (ypT0N0M0) was achieved in 85 patients (18%), with no statistically significant difference between statin users and non-users (22.2% vs. 17.4%, P=0.29). Median DFS (45 vs. 40 months, P=0.25) and OS (44 vs. 42 months, P=0.28) were also not significantly different between the two groups. However, a non-significant trend toward improved DFS was identified in patients with esophageal adenocarcinoma receiving lipophilic statin therapy. Conclusions: In this cohort, statin use was not associated with improved pathologic response or survival outcomes following neoadjuvant therapy for esophageal cancer. These findings do not support modification or discontinuation of statin therapy in this patient population.