阿司匹林使用与胃癌之间的频率-风险和持续时间-风险关系：系统评价和荟萃分析。
Frequency-risk and duration-risk relationships between aspirin use and gastric cancer: a systematic review and meta-analysis.
机构信息
School of Public Health, Guangdong Key Laboratory of Molecular Epidemiology, Guangdong Pharmaceutical University, Guangzhou, Guangdong, China.
出版信息
PLoS One. 2013 Jul 30;8(7):e71522. doi: 10.1371/journal.pone.0071522. Print 2013.
BACKGROUND
Although previous meta-analyses have suggested an association between aspirin use and risk of gastric cancer, current evidence is inconsistent. Additionally, it remains unclear whether there are frequency-risk and duration-risk relationships and if a threshold of effect exists.
METHODS
We identified studies by searching MEDLINE and PUBMED databases and reviewing relevant articles. We derived the summary risk estimates using fixed-effects or random-effects model based on homogeneity analysis. The dose-response meta-analysis was performed by linear trend regression and restricted cubic spline regression. Potential heterogeneity was tested using the Q statistic and quantified with the I (2) statistic. Subgroup analyses and Galbraith plots were used to explore the potential sources of heterogeneity. Publication bias was evaluated with funnel plots and quantified by the Begg's and Egger's test.
RESULTS
Fifteen studies were included in this meta-analysis. There was an overall 29% reduced risk of gastric cancer corresponding to aspirin use (RR = 0.71, 95% CI 0.60-0.82). We found there are nonlinear frequency-risk and linear duration-risk relations between aspirin use and gastric cancer. A monotonically decreasing relation was observed only for low-frequency (≤4.5 times/week) aspirin intake (10% decreased risk for once/week, 19% for twice/week and 29% for 4.5 times/week), and the frequency threshold of aspirin use is 4.5 times per week. Regarding those with duration of aspirin use, there was a tendency towards stronger risk reduction of gastric cancer for longer aspirin use (10% decreased risk for 4 years, 19% for 8 years and 28% for 12 years), and no duration threshold was observed.
CONCLUSION
Our findings suggest that long-term (≥4 years) and low-frequency (1-4.5 times per week) aspirin use is associated with a statistically significant, dose-dependent reduction in the risk of gastric cancer.
背景
尽管之前的荟萃分析表明阿司匹林的使用与胃癌风险之间存在关联，但目前的证据并不一致。此外，目前尚不清楚是否存在频率风险和持续时间风险关系，以及是否存在效应阈值。
方法
我们通过搜索 MEDLINE 和 PUBMED 数据库并审查相关文章来确定研究。我们根据同质性分析使用固定效应或随机效应模型得出汇总风险估计。通过线性趋势回归和限制三次样条回归进行剂量-反应荟萃分析。使用 Q 统计量和 I ² 统计量来测试潜在的异质性，并进行量化。使用亚组分析和 Galbraith 图来探索潜在的异质性来源。使用漏斗图和 Begg's 和 Egger 的检验来评估发表偏倚。
结果
这项荟萃分析共纳入了 15 项研究。阿司匹林的使用与胃癌的总体风险降低了 29%（RR = 0.71，95% CI 0.60-0.82）。我们发现阿司匹林的使用与胃癌之间存在非线性的频率风险和线性的持续时间风险关系。仅在低频率（≤每周 4.5 次）阿司匹林摄入时观察到单调递减关系（每周一次摄入风险降低 10%，每周两次摄入风险降低 19%，每周 4.5 次摄入风险降低 29%），且阿司匹林使用的频率阈值为每周 4.5 次。对于阿司匹林使用持续时间，更长时间使用阿司匹林与胃癌风险降低呈正相关（使用 4 年风险降低 10%，使用 8 年风险降低 19%，使用 12 年风险降低 28%），且未观察到持续时间阈值。
结论
我们的研究结果表明，长期（≥4 年）和低频率（每周 1-4.5 次）使用阿司匹林与胃癌风险呈统计学显著、剂量依赖性降低相关。
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