Statin use and colorectal cancer prognosis: an updated systematic review and meta-analysis

Purpose Statins are affordable and commonly prescribed, but their impact on mortality in patients with colorectal cancer (CRC) remains unclear. Methods A systematic search of PubMed, Embase, and the Cochrane Library identified English-language studies on statin use and CRC mortality published through March 2025. Adjusted hazard ratios (HRs) with 95% confidence intervals (95% CIs) were pooled to calculate summary HRs. Heterogeneity was assessed using the Q-test and I 2 statistic, applying fixed-effects models for I 2 <50% and random-effects models for I 2 ≥50%. Subgroup analyses explored sources of heterogeneity. Results Twenty studies involving 207, 041 patients with CRC were included. Ten studies (131, 599 patients) evaluated prediagnostic statin use, and 13 studies (75, 442 patients) evaluated postdiagnostic statin use. For prediagnostic use, fixed-effects models yielded pooled HRs of 0.87 (95% CI, 0.81–0.92) for all-cause mortality (ACM) and 0.82 (95% CI, 0.78–0.86) for cancer-specific mortality (CSM). For postdiagnostic use, random-effects models showed pooled HRs of 0.81 (95% CI, 0.73–0.89) for ACM and 0.76 (95% CI, 0.69–0.84) for CSM. Subgroup analyses revealed significant differences in ACM by region, tumor location, and follow-up duration with notable findings in European patients. A statistically significant difference was observed between studies with ≥5 years of follow-up and between stage I–III patients. Sensitivity analyses restricted to studies using time-dependent Cox regression produced consistent estimates for both cancer-specific and all-cause mortality. Conclusion Prediagnostic and postdiagnostic statin use were associated with reduced ACM and CSM in patients with CRC. However, given the observational nature of the included studies and the potential for residual confounding, these findings should be interpreted as associations rather than causal effects, and they require confirmation in large-scale, prospective randomized trials.