阿司匹林和 NSAIDs 对结直肠癌风险和生存的影响。

Effect of aspirin and NSAIDs on risk and survival from colorectal cancer.

机构信息

Colon Cancer Genetics Group and Academic Coloproctology, Institute of Genetics and Molecular Medicine, University of Edinburgh and MRC Human Genetics Unit, Western General Hospital, Edinburgh EH4 2XU, UK.

出版信息

Gut. 2010 Dec;59(12):1670-9. doi: 10.1136/gut.2009.203000. Epub 2010 Sep 15.

DOI:10.1136/gut.2009.203000

PMID:20844293

Abstract

BACKGROUND

Previous studies have shown that aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) lower colorectal cancer (CRC) risk. However, the lowest effective NSAID dose, treatment duration, and effects on survival are not defined. In a large population-based case-control study, we have explored the relationship between NSAID dose and duration, CRC risk and overall CRC-specific survival.

METHODS

The relationship between NSAID use and CRC risk was examined in 2279 cases and 2907 controls. Subjects completed food-frequency and lifestyle questionnaires. NSAID categories were low-dose aspirin (75 mg), non-aspirin NSAIDs (NA-NSAIDs) and any NSAID. Users were defined as taking >4 tablets/week for >1 month. ORs were calculated by logistic regression models and adjusted for potential confounding factors. Effect of NSAID use on all-cause and CRC-specific mortality was estimated using Logrank tests and Cox's hazard models.

RESULTS

In all, 354 cases (15.5%) were taking low-dose aspirin compared to 526 controls (18.1%). Low-dose aspirin use was associated with decreased CRC risk (OR 0.78 95% CI 0.65 to 0.92, p=0.004), evident after 1 year and increasing with duration of use (p(trend)=0.004). NA-NSAID and any NSAID use were also inversely associated with CRC. There was no demonstrable effect of NSAIDS on all-cause (HR 1.11, p=0.22, 0.94-1.33) or CRC-specific survival (HR 1.01, p=0.93, 0.83-1.23).

CONCLUSION

This is the first study to demonstrate a protective effect against CRC associated with the lowest dose of aspirin (75 mg per day) after only 5 years use in the general population. NSAID use prior to CRC diagnosis does not influence survival from the disease.

摘要

背景

先前的研究表明，阿司匹林和其他非甾体抗炎药（NSAIDs）可降低结直肠癌（CRC）的风险。但是，尚未确定最低有效 NSAID 剂量、治疗持续时间以及对生存的影响。在一项大型基于人群的病例对照研究中，我们探讨了 NSAID 剂量和持续时间与 CRC 风险以及 CRC 特异性总生存之间的关系。

方法

在 2279 例病例和 2907 例对照中，研究了 NSAID 使用与 CRC 风险之间的关系。受试者完成了食物频率和生活方式调查问卷。NSAID 类别包括低剂量阿司匹林（75mg）、非阿司匹林 NSAIDs（NA-NSAIDs）和任何 NSAID。使用定义为每周>4 片/周，持续>1 个月。使用逻辑回归模型计算 OR，并调整了潜在的混杂因素。使用 Logrank 检验和 Cox 风险模型估计 NSAID 使用对全因和 CRC 特异性死亡率的影响。

结果

共有 354 例（15.5%）病例正在服用低剂量阿司匹林，而 526 例（18.1%）对照正在服用低剂量阿司匹林。低剂量阿司匹林的使用与 CRC 风险降低相关（OR 0.78，95%CI 0.65 至 0.92，p=0.004），这种相关性在 1 年后出现，且随着使用时间的延长而增加（p（趋势）=0.004）。NA-NSAID 和任何 NSAID 的使用也与 CRC 呈负相关。在全因死亡率（HR 1.11，p=0.22，0.94-1.33）或 CRC 特异性生存率（HR 1.01，p=0.93，0.83-1.23）方面，NSAIDs 没有明显的影响。