Asano T K, McLeod R S
Department of Surgery, Mount Sinai Hospital, and Department of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Dis Colon Rectum. 2004 May;47(5):665-73. doi: 10.1007/s10350-003-0111-9. Epub 2004 Apr 2.
A systematic review was conducted to determine the effect of nonsteroidal anti-inflammatory drugs for the prevention or regression of colorectal adenomas and cancer.
Randomized, controlled trials through September 2003 were identified. Nonsteroidal anti-inflammatory drugs were the interventions. The primary outcomes were the number of patients with at least one colorectal adenoma, a change in polyp burden, or colorectal cancer. The secondary outcome was adverse events. Two reviewers independently extracted data and assessed trial quality. Dichotomous outcomes were reported as relative risks with 95 percent confidence intervals. The data were combined if clinically and statistically reasonable.
Nine trials with 150 familial adenomatous polyposis and 24,143 population patients met the inclusion criteria. The interventions included sulindac, celecoxib, or aspirin. From the combined results of three trials, significantly fewer patients in the aspirin group developed recurrent sporadic colorectal adenomas (relative risk, 0.77 (95 percent confidence interval, 0.61, 0.96), number needed to treat 12.5 (95 percent confidence interval, 7.7, 25)) after one to three years. In another three trials, patients with familial adenomatous polyposis who received nonsteroidal anti-inflammatory drugs had a greater proportional reduction (range, 11.9-44 percent) in the number of colorectal adenomas compared with those in the control group (range, 4.5-10 percent). There was no significant difference for the outcomes of colorectal cancer or adverse events in any of the trials.
There is combined evidence from three randomized trials that aspirin significantly reduced the recurrence of sporadic adenomatous polyps. There was evidence from short-term trials to support regression, but not elimination or prevention, of colorectal polyps in familial adenomatous polyposis.
进行一项系统评价，以确定非甾体抗炎药对预防或消退结直肠腺瘤及癌症的效果。
检索截至2003年9月的随机对照试验。干预措施为非甾体抗炎药。主要结局为至少有一个结直肠腺瘤的患者数量、息肉负荷的变化或结直肠癌。次要结局为不良事件。两名研究者独立提取数据并评估试验质量。二分结局以相对风险及95%置信区间报告。若在临床和统计学上合理，则合并数据。
9项试验纳入了150例家族性腺瘤性息肉病患者和24143例普通人群患者，符合纳入标准。干预措施包括舒林酸、塞来昔布或阿司匹林。从三项试验的合并结果来看，阿司匹林组在1至3年后出现复发性散发性结直肠腺瘤的患者明显减少（相对风险，0.77（95%置信区间，0.61，0.96），需治疗人数12.5（95%置信区间，7.7，25））。在另外三项试验中，与对照组（范围为4.5%-10%）相比，接受非甾体抗炎药治疗的家族性腺瘤性息肉病患者的结直肠腺瘤数量成比例减少幅度更大（范围为11.9%-44%）。在任何一项试验中，结直肠癌或不良事件的结局均无显著差异。
三项随机试验的综合证据表明，阿司匹林可显著降低散发性腺瘤性息肉的复发率。短期试验有证据支持家族性腺瘤性息肉病患者的结直肠息肉可消退，但不能消除或预防。
