Channing, Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Int J Cancer. 2011 May 15;128(10):2444-52. doi: 10.1002/ijc.25811. Epub 2011 Feb 26.
Experimental studies suggest a role for aspirin in the chemoprevention of prostate cancer and epidemiological evidence supports a modest inverse association between regular aspirin use and prostate cancer risk, especially for advanced disease. In a prospective cohort study of 51,529 health professionals aged 40-75 years at baseline, we evaluated long-term aspirin use and the incidence of total, high-grade (Gleason 8-10, n = 488), regionally advanced (T3b-T4 or N1, n = 228) and lethal prostate cancer (M1, bony metastases or prostate cancer death, n = 580) from 1988-2006. We used Cox proportional hazards regression to evaluate risk associated with frequency (days/week), quantity (tablets/week), recency and duration of aspirin use after multivariable adjustment for confounders and other predictors of prostate cancer risk. A total of 4,858 men were diagnosed with prostate cancer during the 18-year study period. Men taking ≥ 2 adult-strength aspirin tablets a week had a 10% lower risk of prostate cancer (p-for-trend = 0.02). For regionally advanced cancer, we observed no significant associations with aspirin use. For high-grade and lethal disease, men taking ≥ 6 adult-strength tablets/week experienced similar reductions in risk hazard ratio [HR = 0.72 (95% confidence intervals [CI]: 0.54, 0.96) and HR = 0.71 (95% CI: 0.50, 1.00)]. Analytical approaches to address bias from more frequent prostate-specific antigen screening among aspirin users did not yield different conclusions. We observed reductions in the risk of high-grade and lethal prostate cancer associated with higher doses of aspirin, but not with greater frequency or duration, in a large, prospective cohort of health professionals. Our data support earlier observations of modest inverse associations with advanced prostate cancer.
实验研究表明阿司匹林在前列腺癌的化学预防中具有作用，而流行病学证据支持定期使用阿司匹林与前列腺癌风险之间存在适度的反比关系，尤其是对于晚期疾病。在一项对 51529 名年龄在 40-75 岁的健康专业人员进行的前瞻性队列研究中，我们评估了长期使用阿司匹林与总前列腺癌、高级别（Gleason 8-10，n = 488）、局部进展性（T3b-T4 或 N1，n = 228）和致命性前列腺癌（M1，骨转移或前列腺癌死亡，n = 580）的发生率之间的关系。从 1988 年至 2006 年，我们使用 Cox 比例风险回归分析来评估与频率（每周天数）、数量（每周片数）、近期和阿司匹林使用时间长短相关的风险，同时对混杂因素和其他前列腺癌风险预测因素进行多变量调整。在 18 年的研究期间，共有 4858 名男性被诊断患有前列腺癌。每周服用≥2 片成人剂量阿司匹林的男性患前列腺癌的风险降低 10%（p 趋势=0.02）。对于局部进展性癌症，我们没有观察到与阿司匹林使用相关的显著关联。对于高级别和致命性疾病，每周服用≥6 片成人剂量阿司匹林的男性，其风险降低幅度相似，危险比[HR=0.72（95%置信区间[CI]：0.54，0.96）和 HR=0.71（95% CI：0.50，1.00）]。针对阿司匹林使用者更频繁的前列腺特异性抗原筛查所产生的偏倚进行分析的方法并未得出不同的结论。我们观察到，与较高剂量的阿司匹林相关的高级别和致命性前列腺癌风险降低，但与使用频率或持续时间无关，这是在一个大型前瞻性健康专业人员队列中观察到的结果。我们的数据支持之前关于与晚期前列腺癌适度反比关系的观察结果。
