Statin use is associated with better post‐operative prognosis among patients with hepatitis B virus‐related hepatocellular carcinoma

Background The high postoperative recurrence rate of hepatocellular carcinoma (HCC) is a significant challenge. Patient metabolic factors are potential disease modifiers and should be examined as risk factors for postoperative prognosis. Here, we assessed the association between long‐term statin use and HCC recurrence after surgical resection of hepatitis B virus (HBV)‐related HCC. Methods Patients who initially underwent curative resection for HBV‐related HCC between 2005 and 2015 were recruited and followed up until December 2019. Patients were classified into statin user and non‐statin user groups based on whether or not they had been prescribed statins for ≥2 years. The primary outcome was HCC recurrence, and the secondary outcome was liver‐related mortality. The cumulative incidence by statin use was estimated using the Kaplan–Meier method and compared using the log‐rank test. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox regression. Results Among 5653 patients with a median 6.1 years of follow‐up, HCC recurrence and liver‐related mortality occurred in 1603 and 316 patients, respectively. The 5‐year cumulative incidence of HCC recurrence in the statin user group (15.9%) was significantly lower than that in the non‐user group (21.3%; p = .019). From multivariable Cox regression analysis, statin use was significantly associated with a reduced risk of HCC recurrence (aHR 0.77, 95% CI: 0.61–0.98; p = .035) and liver‐related mortality (aHR 0.48, 95% CI: 0.25–0.90; p = .023). Conclusion Long‐term statin use was significantly associated with reduced risk of HCC recurrence and liver‐related mortality after curative resection of HBV‐related HCC.