MRC Clinical Trials Unit, London, UK.
Br J Cancer. 2011 Oct 11;105(8):1107-13. doi: 10.1038/bjc.2011.289. Epub 2011 Aug 16.
Aspirin inhibits the enzyme cyclooxygenase (Cox), and there is a significant body of epidemiological evidence demonstrating that regular aspirin use is associated with a decreased incidence of developing cancer. Interest focussed on selective Cox-2 inhibitors both as cancer prevention agents and as therapeutic agents in patients with proven malignancy until concerns were raised about their toxicity profile. Aspirin has several additional mechanisms of action that may contribute to its anti-cancer effect. It also influences cellular processes such as apoptosis and angiogenesis that are crucial for the development and growth of malignancies. Evidence suggests that these effects can occur through Cox-independent pathways questioning the rationale of focussing on Cox-2 inhibition alone as an anti-cancer strategy. Randomised studies with aspirin primarily designed to prevent cardiovascular disease have demonstrated a reduction in cancer deaths with long-term follow-up. Concerns about toxicity, particularly serious haemorrhage, have limited the use of aspirin as a cancer prevention agent, but recent epidemiological evidence demonstrating regular aspirin use after a diagnosis of cancer improves outcomes suggests that it may have a role in the adjuvant setting where the risk:benefit ratio will be different.
阿司匹林抑制环氧化酶（Cox），有大量的流行病学证据表明，经常使用阿司匹林可降低癌症的发病率。人们对选择性 Cox-2 抑制剂产生了兴趣，将其作为癌症预防剂和已确诊恶性肿瘤患者的治疗剂，直到对其毒性特征提出担忧。阿司匹林还有其他几种作用机制可能有助于其抗癌作用。它还影响细胞过程，如细胞凋亡和血管生成，这些过程对恶性肿瘤的发展和生长至关重要。有证据表明，这些作用可能通过 Cox 非依赖性途径发生，这对仅关注 Cox-2 抑制作为抗癌策略的合理性提出了质疑。主要用于预防心血管疾病的阿司匹林随机研究表明，长期随访后癌症死亡率降低。对毒性的担忧，特别是严重出血，限制了阿司匹林作为癌症预防剂的使用，但最近的流行病学证据表明，在癌症诊断后经常使用阿司匹林可改善预后，这表明它可能在辅助治疗中有一定作用，在这种情况下，风险与获益的比例将会有所不同。
