Rothwell Peter M
Nuffield Department of Clinical Neuroscience, John Radcliffe Hospital, Oxford, OX39DU, UK.
Recent Results Cancer Res. 2013;191:121-42. doi: 10.1007/978-3-642-30331-9_7.
In addition to longstanding evidence from observational studies, evidence from randomised trials of the effectiveness of aspirin for chemoprevention of colorectal cancer has increased substantially in recent years. Trials have shown that daily aspirin reduces the risk of any recurrent colorectal adenoma by 17 % and advanced adenoma by 28 %, and that daily aspirin for about 5 years reduces incidence and mortality due to colorectal cancer by 30-40 % after 20 years of follow-up, and reduces the 20-year risk of all-cause cancer mortality by about 20 %. Recent evidence also shows that the risk of major bleeding on aspirin diminishes with prolonged use, suggesting that the balance of risk and benefit favours the use of daily aspirin in primary prevention of colorectal and other cancers. Updated clinical guidelines are currently awaited.
除了观察性研究的长期证据外，近年来阿司匹林用于结直肠癌化学预防有效性的随机试验证据也大幅增加。试验表明，每日服用阿司匹林可使任何复发性结直肠腺瘤的风险降低17%，高级别腺瘤的风险降低28%，并且每日服用阿司匹林约5年，在随访20年后可使结直肠癌的发病率和死亡率降低30%-40%，并使全因癌症死亡率的20年风险降低约20%。近期证据还表明，阿司匹林导致大出血的风险会随着使用时间延长而降低，这表明风险与获益的平衡有利于在结直肠癌和其他癌症的一级预防中使用每日阿司匹林。目前正在等待更新的临床指南。
