Statin Use Is Associated with Reduced Risk of Haematological Malignancies: Evidence from a Meta-Analysis

<div><p>Background</p><p>Several observational studies have shown that statin use may modify the risk of haematological malignancies. To quantify the association between statin use and risk for haematological malignancies, we performed a detailed meta-analysis of published studies regarding this subject.</p><p>Methods</p><p>We conducted a systematic search of multiple databases including PubMed, Embase, and Cochrane Library Central database up to July 2013. Fixed-effect and random-effect models were used to estimate summary relative risks (RR) and the corresponding 95% confidence intervals (CIs). Potential sources of heterogeneity were detected by meta-regression. Subgroup analyses and sensitivity analysis were also performed.</p><p>Results</p><p>A total of 20 eligible studies (ten case-control studies, four cohort studies, and six RCTs) reporting 1,139,584 subjects and 15,297 haematological malignancies cases were included. Meta-analysis showed that statin use was associated with a statistically significant 19% reduction in haematological malignancies incidence (RR = 0.81, 95% CI [0.70, 0.92]). During subgroup analyses, statin use was associated with a significantly reduced risk of haematological malignancies among observational studies (RR = 0.79, 95% CI [0.67, 0.93]), but not among RCTs (RR = 0.92, 95% CI [0.77, 1.09]).</p><p>Conclusions</p><p>Based on this comprehensive meta-analysis, statin use may have chemopreventive effects against haematological malignancies. More studies, especially definitive, randomized chemoprevention trials are needed to confirm this association.</p></div

Subgroup analysis of all studies.

<p>No, number; RR, relative risks; CIs, confidence intervals; RCTs, randomized, controlled trials.</p

Forest plot: estimates (95% CIs) of statin use and risk of haematological malignancies.

<p>Squares indicated study-specific risk estimates (size of square reflects the study-statistical weight, i.e. inverse of variance); horizontal lines indicate 95% confidence intervals; diamond indicates summary relative risk estimate with its corresponding 95% confidence interval.</p

Characteristics of included studies assessing the risk of haematological malignancies with statin use.

<p>NR = not reported; RR = Relative risk; HR = Hazard ratio; OR = Odds ratio; M =  male; F = female; BMI = body mass index; RCT =  randomized controlled trial.</p

Performance of Real-Time Elastography for the Staging of Hepatic Fibrosis: A Meta-Analysis

<div><p>Background</p><p>With the rapid development of real-time elastography (RTE), a variety of measuring methods have been developed for the assessment of hepatic fibrosis. We evaluated the overall performance of four methods based on RTE by performing meta-analysis of published literature.</p><p>Methods</p><p>Online journal databases and a manual search from April 2000 to April 2014 were used. Studies from different databases that meet inclusion criteria were enrolled. The statistical analysis was performed using a random-effects model and fixed-effects model for the overall effectiveness of RTE. The area under the receiver operating characteristic curve (AUROC) was calculated for various means. Fagan plot analysis was used to estimate the clinical utility of RTE, and the heterogeneity of the studies was explored with meta-regression analysis.</p><p>Results</p><p>Thirteen studies from published articles were enrolled and analyzed. The combined AUROC of the liver fibrosis index (LFI) for the evaluation of significant fibrosis (F≥2), advanced fibrosis (F≥3), and cirrhosis (F = 4) were 0.79, 0.94, and 0.85, respectively. The AUROC of the elasticity index (EI) ranged from 0.75 to 0.92 for F≥2 and 0.66 to 0.85 for F = 4. The overall AUROC of the elastic ratio of the liver for the intrahepatic venous vessels were 0.94, 0.93, and 0.96, respectively. The AUROC of the elastic ratio of the liver for the intercostal muscle in diagnosing advanced fibrosis and cirrhosis were 0.96 and 0.92, respectively. There was significant heterogeneity in the diagnostic odds ratio (DOR) for F≥2 of LFI mainly due to etiology (<i>p</i><0.01).</p><p>Conclusion</p><p>The elastic ratio of the liver for the intrahepatic vein has excellent precision in differentiating each stage of hepatic fibrosis and is recommend to be applied to the clinic.</p></div

Forest plot from meta-analysis of DOR value using a random-effect or fixed-effect model for significant fibrosis.

<p>(A) Forest plot of LFI and (B) Forest plot of ER1 and (C) Forest plot of ER2. DOR: diagnostic odds ratio; LFI: liver fibrosis index; ER1: the elastic ratio of the liver for the intrahepatic vein; ER2: the elastic ratio of the liver for the intercostal muscle; Ochi (a): the training set of the subjects in the study by Ochi et al; Ochi (b): the validating set of the subjects in the study by Ochi et al.</p

Characteristics of studies evaluating the performance of real time elastography for staging liver fibrosis.

<p>RTE, real time elastography; LFI, liver fibrosis index; ER1, the elastic ratio of the liver for the intrahepatic venous; ER2, the elastic ratio of the liver for the intercostal muscle; EI, elastic ratio; CHB, chronic hepatitis B; CHC, chronic hepatitis C; ALD, alcoholic liver disease, NAFLD, nonalcoholic liver fatty disease; AIH, autoimmune hepatitis; PBC, primary biliary cirrhosis.</p><p>Characteristics of studies evaluating the performance of real time elastography for staging liver fibrosis.</p

Forest plot from meta-analysis of DOR value using a random-effect or fixed-effect model for significant fibrosis.

<p>(A) Forest plot of LFI and (B) Forest plot of ER1 and (C) Forest plot of ER2. DOR: diagnostic odds ratio; LFI: liver fibrosis index; ER1: the elastic ratio of the liver for the intrahepatic vein; ER2: the elastic ratio of the liver for the intercostal muscle; Ochi (a): the training set of the subjects in the study by Ochi et al; Ochi (b): the validating set of the subjects in the study by Ochi et al.</p