Wang Wei Hong, Huang Jia Qing, Zheng Ge Fan, Lam Shiu Kum, Karlberg Johan, Wong Benjamin Chun-Yu
Department of Gastroenterology, First Hospital, Peking University, Beijing, China.
J Natl Cancer Inst. 2003 Dec 3;95(23):1784-91. doi: 10.1093/jnci/djg106.
The relationship between the use of non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin, and the risk of gastric cancer has not been well studied. We performed a systematic review and meta-analysis of published studies to evaluate the association between use of this class of drugs and the risk of gastric cancer.
A fully recursive literature search to January 2003 was conducted in MEDLINE, PubMed, and CANCERLIT to identify potentially relevant case-control or cohort studies. Summary odds ratios (ORs) and 95% confidence intervals (CIs) were calculated under a random-effects model.
Nine studies (eight case-control and one cohort) with a total of 2831 gastric cancer case patients were identified. NSAID use was associated with a reduced risk of gastric cancer, with a summary odds ratio of 0.78 (95% CI = 0.69 to 0.87). Users of aspirin (OR = 0.73, 95% CI = 0.63 to 0.86) and non-aspirin NSAIDs (OR = 0.74, 95% CI = 0.55 to 1.00) experienced similar magnitudes of risk reduction. Regular users of NSAIDs (OR = 0.57, 95% CI = 0.44 to 0.74) experienced a lower risk of gastric cancer relative to nonusers than did irregular users (OR = 0.76, 95% CI = 0.62 to 0.94; P =.09 versus regular users). A stratified analysis showed that NSAID use was associated with a statistically significant reduction in risk of noncardia gastric cancer (OR = 0.72, 95% CI = 0.58 to 0.89), but not of gastric cancer at the cardia (OR = 0.80, 95% CI = 0.53 to 1.20). There was no evidence that study design or type of control subject substantially influenced the estimate of effects.
NSAID use was associated with a decreased risk of gastric cancer in a dose-dependent manner. This finding warrants proper clinical trials in populations with high risk of gastric cancer.
包括阿司匹林在内的非甾体抗炎药（NSAIDs）的使用与胃癌风险之间的关系尚未得到充分研究。我们对已发表的研究进行了系统评价和荟萃分析，以评估这类药物的使用与胃癌风险之间的关联。
在MEDLINE、PubMed和CANCERLIT中进行了全面的递归文献检索，直至2003年1月，以确定潜在相关的病例对照研究或队列研究。在随机效应模型下计算汇总比值比（OR）和95%置信区间（CI）。
共确定了9项研究（8项病例对照研究和1项队列研究），涉及2831例胃癌患者。使用NSAIDs与胃癌风险降低相关，汇总比值比为0.78（95%CI=0.69至0.87）。阿司匹林使用者（OR=0.73，95%CI=0.63至0.86）和非阿司匹林NSAIDs使用者（OR=0.74，95%CI=0.55至1.00）的风险降低幅度相似。与非使用者相比，NSAIDs的规律使用者（OR=0.57，95%CI=0.44至0.74）患胃癌的风险低于不规律使用者（OR=0.76，95%CI=0.62至0.94；与规律使用者相比，P=0.09）。分层分析表明，使用NSAIDs与非贲门胃癌风险的统计学显著降低相关（OR=0.72，95%CI=0.58至0.89），但与贲门胃癌风险无关（OR=0.80，95%CI=0.53至1.20）。没有证据表明研究设计或对照对象类型对效应估计有实质性影响。
NSAIDs的使用与胃癌风险降低呈剂量依赖性相关。这一发现值得在胃癌高危人群中进行适当的临床试验。
