在巴尔的摩纵向衰老研究中，非甾体抗炎药与前列腺癌风险

Nonsteroidal anti-inflammatory drugs and risk of prostate cancer in the Baltimore Longitudinal Study of Aging.

作者信息

Platz Elizabeth A, Rohrmann Sabine, Pearson Jay D, Corrada Maria M, Watson Douglas J, De Marzo Angelo M, Landis Patricia K, Metter E Jeffrey, Carter H Ballentine

机构信息

Department of Epidemiology, Room E6138, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.

出版信息

Cancer Epidemiol Biomarkers Prev. 2005 Feb;14(2):390-6. doi: 10.1158/1055-9965.EPI-04-0532.

DOI:10.1158/1055-9965.EPI-04-0532

PMID:15734963

Abstract

BACKGROUND

Laboratory and epidemiologic studies suggest that aspirin and nonaspirin nonsteroidal anti-inflammatory drugs (NSAID) reduce the risk of cancer, possibly via inhibition of the cyclooxygenase enzymes. We evaluated the association of aspirin and nonaspirin NSAIDs with subsequent prostate cancer in a prospective study. We also assessed whether use of these drugs influences serum prostate-specific antigen (PSA) concentration.

METHODS

Participants were 1,244 male members of the Baltimore Longitudinal Study of Aging. Use of prescription and over-the-counter drugs was collected by questionnaire and interview at multiple study visits. One hundred forty-one prostate cancer cases diagnosed between 1980 and May 2004 were confirmed by medical record review. We used Cox proportional hazards regression to estimate the rate ratio (RR) of prostate cancer updating drug use over time and taking into account age and year. We used generalized estimating equations to calculate age-adjusted geometric mean PSA concentration by aspirin or nonaspirin NSAIDs use among 933 of the men without prostate cancer, for whom 3,749 PSA measurements in archived sera had been done previously.

RESULTS

On 46.0% and 21.5% of the visits, current use of aspirin or nonaspirin NSAIDs (mostly ibuprofen) was reported, respectively. The RRs of prostate cancer comparing ever to never use were 0.76 [95% confidence interval (95% CI), 0.54-1.07] for aspirin, 0.79 (95% CI, 0.54-1.16) for nonaspirin NSAIDs, and 0.71 (95% CI, 0.49-1.02) for either medication. The association for ever use of either aspirin or nonaspirin NSAIDs was suggestively more pronounced in men <70 years (RR, 0.54; 95% CI, 0.27-1.03) than in men >/=70 years (RR, 0.78; 95% CI, 0.50-1.22; P(interaction) = 0.73). The RR for current use of either drug was attenuated relative to ever use. Mean PSA concentration did not differ between users and nonusers of either aspirin or nonaspirin NSAIDs (1.01 versus 0.98 ng/mL, P = 0.56).

CONCLUSION

In this prospective study, men, in particular younger men, who had ever used aspirin or nonaspirin NSAIDs had a modest nonstatistically significant lower risk of prostate cancer. The modest inverse association was unlikely due to detection bias that might have resulted if anti-inflammatory drugs had influenced serum PSA concentration.

摘要

背景

实验室和流行病学研究表明，阿司匹林及非阿司匹林类非甾体抗炎药（NSAID）可能通过抑制环氧化酶来降低癌症风险。我们在一项前瞻性研究中评估了阿司匹林和非阿司匹林类NSAID与后续前列腺癌的关联。我们还评估了这些药物的使用是否会影响血清前列腺特异性抗原（PSA）浓度。

方法

参与者为巴尔的摩衰老纵向研究中的1244名男性成员。通过问卷调查和多次研究访视时的访谈收集处方药和非处方药的使用情况。通过病历审查确诊了1980年至2004年5月期间诊断出的141例前列腺癌病例。我们使用Cox比例风险回归来估计随着时间推移更新药物使用情况并考虑年龄和年份的前列腺癌发病率比（RR）。我们使用广义估计方程来计算933名无前列腺癌男性中按阿司匹林或非阿司匹林类NSAID使用情况调整年龄后的几何平均PSA浓度，这些男性之前已对存档血清进行了3749次PSA测量。

结果

在46.0%和21.5%的访视中，分别报告了当前使用阿司匹林或非阿司匹林类NSAID（主要是布洛芬）的情况。与从未使用相比，阿司匹林使用者前列腺癌的RR为0.76 [95%置信区间（95%CI），0.54 - 1.07]，非阿司匹林类NSAID使用者为0.79（95%CI，0.54 - 1.16），两种药物使用者均为0.71（95%CI，0.49 - 1.02）。在年龄<70岁的男性中，使用过阿司匹林或非阿司匹林类NSAID的关联（RR，0.54；95%CI，0.27 - 1.03）比年龄≥70岁的男性（RR，0.78；95%CI，0.50 - 1.22；P（交互作用） = 0.73）更明显。与曾经使用相比，当前使用任何一种药物的RR都有所降低。阿司匹林或非阿司匹林类NSAID使用者与非使用者之间的平均PSA浓度无差异（1.01对0.98 ng/mL，P = 0.56）。