Department of Urology, University of Washington School of Medicine, Seattle, WA 98195, USA.
Urol Oncol. 2013 Nov;31(8):1689-95. doi: 10.1016/j.urolonc.2012.06.001. Epub 2012 Jul 12.
Literature on the chemopreventive role of nonsteroidal anti-inflammatory drugs (NSAIDs) in urothelial carcinoma of the bladder (UC) is conflicting. A recent pooled analysis of 3 cohorts reported regular use of nonaspirin NSAIDs was associated with reduced risk of urothelial carcinoma (UC) among nonsmokers only; however, nonsmokers are a group with a low risk of UC. We examine the association between NSAID use and UC risk.
Study participants were members of the VITamins and Lifestyle (VITAL) cohort of 77,048 Washington State residents aged 50-76 years who completed a baseline questionnaire in 2000-2002 on NSAID use and cancer risk factors. Ten-year use of aspirin and other NSAIDs was categorized as none, low-use (1-3 d/wk or <4 years), or high-use (≥ 4 d/wk and ≥ 4 years). Incident UC cases were prospectively identified via linkage to a local cancer registry. Hazard ratios (HR) were estimated by multivariate Cox regression.
A total of 385 incident cases of UC were diagnosed over a mean follow-up of 7 years. There was no association with NSAID use and risk of UC. However, the association of use of nonaspirin NSAIDs with UC risk differed by smoking status (P for interaction = 0.02). Specifically, among long-term former smokers (quit ≥ 10 years), nonaspirin NSAID use was associated with a 31% reduction in risk of UC in low-users (HR 0.69, 95% CI 0.46-1.04), and 48% reduction in risk for high-users (HR 0.52, 95% CI 0.24-1.11, P for trend = 0.02).
Our results show a risk reduction with nonaspirin NSAID use among long-term quitters, a group with significant risk of UC.
关于非甾体抗炎药（NSAIDs）在膀胱癌（UC）中的化学预防作用的文献存在矛盾。最近对 3 个队列的汇总分析报告称，非吸烟者经常使用非阿司匹林类 NSAIDs 可降低患膀胱癌的风险；然而，非吸烟者是 UC 风险较低的人群。我们研究了 NSAID 使用与 UC 风险之间的关系。
研究参与者是华盛顿州 77048 名年龄在 50-76 岁的 VITamins 和 Lifestyle（VITAL）队列的成员，他们在 2000-2002 年完成了关于 NSAID 使用和癌症危险因素的基线问卷。10 年的阿司匹林和其他 NSAID 使用情况分为不使用、低剂量使用（每周 1-3 天或<4 年）或高剂量使用（每周≥4 天且≥4 年）。通过与当地癌症登记处的链接，前瞻性地确定 UC 病例。使用多变量 Cox 回归估计危险比（HR）。
在平均 7 年的随访中，共诊断出 385 例 UC 病例。NSAID 使用与 UC 风险之间没有关联。然而，非阿司匹林类 NSAID 使用与 UC 风险的关联因吸烟状况而异（交互作用 P 值=0.02）。具体而言，在长期前吸烟者（戒烟≥10 年）中，非阿司匹林类 NSAID 低剂量使用者的 UC 风险降低了 31%（HR 0.69，95%CI 0.46-1.04），高剂量使用者的风险降低了 48%（HR 0.52，95%CI 0.24-1.11，趋势 P 值=0.02）。
我们的结果显示，在 UC 风险较高的长期戒烟者中，非阿司匹林类 NSAID 使用可降低风险。
