Abstract
BACKGROUND: Colorectal cancer (CRC) is a leading cause of global cancer incidence and mortality. While the anti-tumor potential of statins has gained increasing attention, their exact impact on patient prognosis remains controversial. This systematic review and meta-analysis aims to comprehensively assess the association between statin use and survival outcomes in patients with CRC. METHODS: We systematically searched the PubMed, Embase, Cochrane Library, and Web of Science databases for studies published from inception until October 31, 2025, that compared the impact of statin use versus non-use on the prognosis of patients with CRC. The quality of the included studies was assessed using the Newcastle-Ottawa Scale. The effect of statins was measured using hazard ratios (HRs) with 95% confidence intervals (CIs), and a random-effects model was employed for all pooled analyses. RESULTS: A total of 25 observational studies involving 179, 979 CRC patients were included. Statin use was significantly associated with reduced ACM (HR: 0.80; 95%CI: 0.74-0.86; P < 0.001) and CSM (HR: 0.77; 95%CI: 0.73-0.81; P < 0.001) in CRC patients. These benefits were consistently observed in both pre-diagnosis (ACM: HR = 0.78; CSM: HR = 0.78) and post-diagnosis statin use (ACM: HR = 0.83; CSM: HR = 0.75). However, no significant association was found between statin use and DFM (HR: 0.88; 95%CI: 0.60-1.29; P = 0.513) or RFM (HR: 1.01; 95%CI: 0.94-1.09; P = 0.831). CONCLUSION: Statin use is associated with a significant reduction in ACM and CSM among CRC patients. This benefit is consistently observed with both pre-diagnosis and post-diagnosis use, suggesting statins may serve as a potential intervention to improve prognosis in CRC patients.t. SYSTEMATIC REVIEW REGISTRATION: https://inplasy.com/, identifier INPLASY2025110064.