Effect of statin use on prognostic outcomes in hepatocellular carcinoma following liver surgery: a systematic review and meta-analysis

Hepatocellular carcinoma (HCC) recurrence remains a significant clinical challenge, even among patients who undergo surgical treatment. Although statins exhibit anticancer properties through several biologically plausible mechanisms, robust clinical evidence supporting their role in preventing HCC recurrence is still limited. This meta-analysis aimed to evaluate the impact of statin use on the prognostic outcomes of patients undergoing either liver transplantation or surgical resection. This study adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines and identified relevant studies from electronic databases, including PubMed, Cochrane Library, Scopus, EBSCOhost, and ProQuest. The quality of the included studies was appraised using the Newcastle-Ottawa Scale tool. A meta-analysis was performed by estimating the hazard ratio (HR) with a 95% confidence interval (CI). A total of 15 studies encompassing 37 160 patients were included, with most evaluating statin use after surgical resection. The overall quality assessment yielded a low risk of bias. Our findings highlight a significant benefit of statin use following either liver transplant or resection, showing a significant improvement in overall survival (HR, 0.50; 95% CI, 0.40–0.61; P < 0.001). Moreover, further analysis also revealed that statins were associated with improved recurrence-free survival of HCC (HR, 0.56; 95% CI, 0.49–0.65; P < 0.001). Our study suggests that statins exert a protective effect, reflected in improved survival and reduced HCC recurrence. These findings support the potential role of statins as an adjunctive therapy in HCC management, potentially improving long-term outcomes. Further research is needed to confirm survival outcomes and safety.