Gatenby Piers A, Ramus James R, Caygill Christine P, Winslet Marc C, Watson Anthony
UK National Barrett's Oesophagus Registry (UKBOR), Division of Surgical and Interventional Science, University College London, Royal Free Campus, London, UK.
Eur J Cancer Prev. 2009 Sep;18(5):381-4. doi: 10.1097/CEJ.0b013e32832e0955.
Barrett's columnar-lined oesophagus is the precursor lesion for oesophageal adenocarcinoma. The overall rate of progression to adenocarcinoma is 0.59% per annum. A large prospective multicentre trial is recruiting to assess the role of aspirin as a chemoprotective agent in prevention of development of cancer as well as cardiovascular protection in patients with Barrett's oesophagus. This retrospective analysis of the large UK National Barrett's Oesophagus Registry database seeks to analyse this question from within its large natural history study cohort. Multicentre UK retrospective cohort compared patients known to have been taking aspirin with those who did not take aspirin during the course of surveillance for columnar-lined oesophagus. End point was development of dysplasia or oesophageal adenocarcinoma. Analysis was undertaken using Cox's proportional hazard ratio. Total follow-up was 3683 patient-years. Eighty-six patients were taking aspirin, 650 were not taking aspirin (reference group). Numbers of patients developing all grades of dysplasia and adenocarcinoma were: 13 aspirin (15.1%) and 97 no aspirin (14.9%) (hazard ratio 0.723, 95% confidence interval 0.410-1.310, P = 0.294), high-grade dysplasia and adenocarcinoma: five aspirin (5.8%) and 25 no aspirin (3.8%) (hazard ratio 0.898, 95% confidence interval 0.340-2.368, P = 0.827) and adenocarcinoma: four aspirin (4.7%) and 16 no aspirin (2.5%) (hazard ratio 1.092, 95% confidence interval 0.358-3.335, P = 0.877). No significant difference was observed in hazard of developing dysplasia or adenocarcinoma between patients taking aspirin and those not taking aspirin during the course of follow-up of surveillance for columnar-lined oesophagus. In conclusion, no difference in risk of development of dysplasia or adenocarcinoma was observed between patients taking aspirin and those not taking aspirin in this large cohort.
巴雷特柱状上皮化生食管是食管腺癌的前驱病变。其发展为腺癌的总体年发生率为0.59%。一项大型前瞻性多中心试验正在招募患者，以评估阿司匹林作为化学预防剂在预防巴雷特食管患者癌症发生以及心血管保护方面的作用。这项对英国国家巴雷特食管登记数据库的回顾性分析旨在从其大型自然史研究队列中分析这个问题。英国多中心回顾性队列研究比较了在柱状上皮化生食管监测过程中已知服用阿司匹林的患者和未服用阿司匹林的患者。终点是发育异常或食管腺癌的发生。使用Cox比例风险比进行分析。总随访时间为3683患者年。86名患者服用阿司匹林，650名患者未服用阿司匹林（参照组）。发生各级发育异常和腺癌的患者数量分别为：服用阿司匹林组13例（15.1%），未服用阿司匹林组97例（14.9%）（风险比0.723，95%置信区间0.410 - 1.310，P = 0.294）；高级别发育异常和腺癌：服用阿司匹林组5例（5.8%），未服用阿司匹林组25例（3.8%）（风险比0.898，95%置信区间0.340 - 2.368，P = 0.827）；腺癌：服用阿司匹林组4例（4.7%），未服用阿司匹林组16例（2.5%）（风险比1.092，95%置信区间0.358 - 3.335，P = 0.877）。在柱状上皮化生食管监测随访过程中，服用阿司匹林的患者和未服用阿司匹林的患者在发生发育异常或腺癌的风险方面未观察到显著差异。总之，在这个大型队列中，服用阿司匹林的患者和未服用阿司匹林的患者在发生发育异常或腺癌的风险上没有差异。
