EBM

CRITICAL APPRAISAL
Use of Statins and the Risk of Death in Patients With
Prostate Cancer
Disusun oleh :
Rizkie Arianti Putri Noor 110010!"
Ra#it$a Sakti Pra%o&o 1100111'
Dosen Pe(%i(%in) :
#r* En#ah Purna(asari S+Pk
FAKULTAS KEDOKTERAN UNIERSITAS !ARSI
APRIL "#$%
EBM
T,-AS E.IDENCE BASED MEDICINE
Skenario
Pria &er'sia (" tah'n datan) ke r'*ah sakit den)an ke+'han s'+it &'an) air keci+ dan *erasa n,eri
saat di ke+'arkan se-ak " *in))' ,an) +a+'. Pada /e*eriksaan co+ok d'&'r0 tera&a /rostat ,an)
*e*&esar0 /er*'kaan ,an) keras dan &er&en-o+1&en-o+. Sete+ah di+ak'kan /e*eriksaan radio+o)i
da/at didia)nosis &en-o+an terse&'t ada+ah kanker /rostat. Dokter *e*&eraikan tera/i statin. Ke+'ar)a
/asien *enan,akan a/akah statin da/at *e*/er/an-an) an)ka hara/an hid'/ dari /asien.
Pertan$aan /0ore)roun# 1uestion2
2a)ai*anakah /er&andin)an 3akt' hid'/ /enderita kanker /rostat ,an) di&erikan /en)o&atan den)an
statin dan /enderita kanker /rostat ,an) tidak *en))'nakan statin4
PIC3
Po/'+ation 5 Pasien +aki +aki de3asa den)an ke+'han s'+it &'an) air keci+.
Inter6ention 5 7en))'nakan Statin
Co*/arison 5 Tidak *en))'nakan statin
O'tco*es 5 Penin)katan an)ka hid'/ ,an) +e&ih +a*a
Pen4arian %ukti il(iah
A+a*at 3e&site 5 333.3e&.e&scohost.co*
Kata k'nci 5 Prostate Cancer AND Statins AND Death
Li*itasi 5 8an'ari "##9 : Dese*&er "#$%
;asi+ Pencarian 5 $%
Di+ilih artikel %er5u#ul :
Use of Statins and the Risk of Death in Patients With Prostate Cancer
REVIEW JURNAL
Pendah'+'an
To deter*ine 3hether the 'se of statins after /rostate cancer dia)nosis is associated 3ith a
decreased risk of cancer1re+ated *orta+it, and a++1ca'se *orta+it, and to assess 3hether this
association is *odified &, /redia)nostic 'se of statins.
7etoda
A cohort of $$0<<" *en ne3+, dia)nosed 3ith non*etastatic /rostate cancer &et3een A/ri+ $0 $99=0
and Dece*&er >$0 "##90 fo++o3ed 'nti+ Octo&er $0 "#$"0 3as identified 'sin) a +ar)e
/o/'+ation1&ased e+ectronic data&ase fro* the United Kin)do*. Ti*e1de/endent Co? /ro/ortiona+
ha@ards *ode+s 3ere 'sed to esti*ate ad-'sted ha@ard ratios A;RsB 3ith 9CD CIs of *orta+it,
"
o'tco*es associated 3ith /ostdia)nostic 'se of statins0 +a))ed &, $ ,ear to acco'nt for +atenc,
considerations and to *ini*i@e re6erse ca'sa+it,0 and considerin) effect *odification &,
/redia)nostic 'se of statins.
;asi+
D'rin) a *ean fo++o31'/ ti*e of %.% ,ears Astandard de6iation0 ".9 ,earsB0 >0%99 deaths occ'rred0
inc+'din) $0<9$ fro* /rostate cancer. Postdia)nostic 'se of statins 3as associated 3ith a decreased
risk of /rostate cancer *orta+it, A;R0 #.<(E 9CD CI0 #.(( to #.==B and a++1ca'se *orta+it, A;R0 #.=(E
9CD CI0 #.<= to #.9CB. These decreased risks of /rostate cancer *orta+it, and a++1ca'se *orta+it, 3ere
*ore /rono'nced in /atients 3ho a+so 'sed statins &efore dia)nosis A;R0 #.CCE 9CD CI0 #.%$ to #.<%E
and ;R0 #.((E 9CD CI0 #.C> to #.=$0 res/ecti6e+,B0 3ith 3eaker effects in /atients 3ho initiated the
treat*ent on+, after dia)nosis A;R0 #.="E 9CD CI0 #.<$ to #.9(E and ;R0 #.9$E 9CD CI0 #.=" to $.#$0
res/ecti6e+,B.
Kesi*/'+an
O6era++0 the 'se of statins after dia)nosis 3as associated 3ith a decreased risk in /rostate
cancer *orta+it,. ;o3e6er0 this effect 3as stron)er in /atients 3ho a+so 'sed statins
&efore dia)nosis.
APA6A7 7ASIL PENELITIAN TERSEB,T .ALID8
A. Pet'n-'k Pri*er
$. A/akah terda/at sa*/e+ ,an) re/resentatif0 terdefinisi -e+as0 dan &erada /ada kondisi ,an) sa*a
da+a* /er-a+anan /en,akitn,a4
Patients and Methods
A cohort of 11,772 men newly diagnosed with nonmetastatic prostate cancer between April
1, 1998, and December 31, 2009, followed ntil !ctober 1, 2012, was identified sing a large
poplation"based electronic database from the #nited $ingdom%
". A/akah fo++o31'/ c'k'/ +a*a dan +en)ka/8
Results
Dring a mean follow"p time of &%& years 'standard de(iation, 2%9 years), 3,&99 deaths
occrred, inclding 1,791 from prostate cancer% *ostdiagnostic se of statins was associated
with a decreased ris+ of prostate cancer mortality ',-, 0%7./ 901 23, 0%.. to 0%88) and all"
case mortality ',-, 0%8./ 901 23, 0%78 to 0%90)% 4hese decreased ris+s of prostate cancer
mortality and all"case mortality were more prononced in patients who also sed statins
before diagnosis ',-, 0%00/
901 23, 0%&1 to 0%7&/ and ,-, 0%../ 901 23, 0%03 to 0%81, respecti(ely), with wea+er effects
in patients who initiated the treatment only after diagnosis ',-, 0%82/ 901 23, 0%71 to 0%9./
and ,-, 0%91/ 901 23, 0%82 to 1%01, respecti(ely)
2. Pet'n-'k sek'nder
$. A/akah kriteria o'tco*e ,an) di)'nakan o&,ektif dan tan/a &ias4
Data Sources
>
This study was conducted by linking the following four large electronic databases from the United
Kingdom: the United Kingdom National Cancer Registry, the Clinical Practice Research Datalink
CPRD! "re#iously known as the $eneral Practice Research Database%, the &os"ital '"isode (tatistics
&'(% database, and the )ffice for National (tatistics )N(% database* The United Kingdom National
Cancer Registry contains tumor information, including site of "rimary growth coded using the
+nternational Classification of Diseases,
,-th Re#ision .+CD/,-0% and tumor characteristics such as grade, stage, and "rimary treatments
recei#ed, although not consistently recorded%* The CPRD contains data on more than ,1 million
indi#iduals enrolled in more than 23- general "ractices*,3 The &'( database contains dates of
hos"ital admissions, "rimary and secondary diagnoses coded using the +CD/,- classification%, and
related "rocedures coded using the +CD/,- classification and
)ffice of Po"ulation Censuses and (ur#eys Classification of +nter#entions and Procedures, 4ourth
5ersion%* 4inally, the )N( contains the electronic death certificates of all citi6ens li#ing in the United
Kingdom and was used to identify the underlying cause of death coded using the +CD/,-
classification% for all "atients who died during follow/u"* The study "rotocol was a""ro#ed by the
+nde"endent (cientific 7d#isory Committee of the CPRD and the Research 'thics 8oard of the
9ewish $eneral &os"ital, :ontreal, ;uebec, Canada*
". 2i+a dite*'kan s'&)r'/ den)an /ro)nosis ,an) &eda0 a/akah di+ak'kan ad-'st*ent 'nt'k faktor1
faktor /ro)nostik ,an) /entin)4
%
C
>. A/akah di+ak'kan 6a+idasi /ada s'at' ke+o*/ok inde/enden Atest1setB4
TIDAK
APA 7ASILN9A8
$. 2a)ai*ana )a*&aran o'tco*e *en'r't 3akt'4
A tota+ of $$0<<" /atients ne3+, dia)nosed 3ith non*etastatic /rostate cancer *et the st'd,
inc+'sion criteria. The *ean a)e at cohort entr, 3as <$.> ,ears Astandard de6iation0 =.= ,earsB0
3ith a *ean fo++o31'/ ti*e of %.% ,ears Astandard de6iation0 ".9 ,earsB. The corres/ondin)
incidence rates of /rostate cancer *orta+it, and a++ ca'se *orta+it, 3ere >%.= /er $0### /er ,ear
A9CD CI0 >>." to >(.% /er $0### /er ,earB and (<.9 /er $0### /er ,ear A9CD CI0 (C.< to <#." /er
$0### /er ,earB0 res/ecti6e+,.
". Se&era/a te/at /erkiraan /ro)nosis4
APA6A7 7ASIL PENELITIAN INI DAPAT DIAPLI6ASI6AN8
$. A/akah /asien da+a* /ene+itian terse&'t ser'/a den)an /asien sa,a4
!A
(
". A/akah hasi+ terse&'t *e*&ant' *e*i+ih ata' *en)hindari tera/i tertent'4
TIDAK
Da+a* -'rna+ /ene+itian ini tidak dise&'tkan &ah3a /e*i+ihan tera/i tertent' *e*/en)ar'hi
hasi+ /ro)nosis kanker /rostat.
>. A/akah hasi+n,a *e*&ant' da+a* *e*&erikan konse+in) ke/ada /asien sa,a4
!A
Da+a* -'rna+ /ene+itian ini dise&'tkan &ah3a hasi+ /en))'naan statin da/at *e*/er/an-an)
an)ka hara/an hid'/ /asien /enderita kanker /rostat.
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