1] Department of Gastroenterology, Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing 210008, China [2] Medical School of Nanjing University, Nanjing 210008, China.
Department of Intensive Care Medicine, University of Tampere Medical School, Tampere 33014, Finland.
Br J Cancer. 2014 Apr 29;110(9):2378-88. doi: 10.1038/bjc.2014.127. Epub 2014 Mar 20.
Esophageal adenocarcinoma (EAC) has high mortality and is increasing in incidence. Barrett's esophagus (BE) increases the risk for EAC. Studies have reported inconsistent findings on the association between use of cyclooxygenase (COX) inhibitors and the risk of neoplastic progression in BE patients. Therefore, we performed a meta-analysis to investigate this association.
A meta-analysis was undertaken among a total of 9 observational studies using fixed- and random-effects models, comprising 5446 participants; 605 had EAC or high-grade dysplasia (HGD).
Overall, COX inhibitors use was associated with a reduced risk of EAC/HGD among BE patients (relative risk (RR)=0.64, 95% confidence interval (CI)=0.53-0.77). Aspirin use also reduced the risk of EAC/HGD (RR=0.63, 95% CI=0.43-0.94), as well as non-aspirin COX inhibitors (RR=0.50, 95% CI=0.32-0.78). The chemopreventive effect seemed to be independent of duration response.
Cyclooxygenase inhibitors use is associated with a reduced risk of developing EAC in patients with BE. Both low-dose aspirin and non-aspirin COX inhibitors are associated with a reduced risk of neoplasia. More well-designed randomised controlled trials are needed to increase our understanding of the chemopreventive effect of COX inhibitors.
食管腺癌（EAC）死亡率高，发病率呈上升趋势。巴雷特食管（BE）增加了 EAC 的风险。研究报告称，环氧化酶（COX）抑制剂的使用与 BE 患者肿瘤进展的风险之间存在不一致的关联。因此，我们进行了一项荟萃分析来研究这种关联。
我们对总共 9 项观察性研究进行了荟萃分析，使用固定效应和随机效应模型，共纳入 5446 名参与者；其中 605 名患者患有 EAC 或高级别上皮内瘤变（HGD）。
总体而言，COX 抑制剂的使用与 BE 患者 EAC/HGD 的风险降低相关（相对风险（RR）=0.64，95%置信区间（CI）=0.53-0.77）。阿司匹林的使用也降低了 EAC/HGD 的风险（RR=0.63，95% CI=0.43-0.94），以及非阿司匹林 COX 抑制剂（RR=0.50，95% CI=0.32-0.78）。这种化学预防作用似乎与持续时间无关。
COX 抑制剂的使用与 BE 患者发生 EAC 的风险降低有关。低剂量阿司匹林和非阿司匹林 COX 抑制剂均与降低肿瘤风险有关。需要更多设计良好的随机对照试验来增加我们对 COX 抑制剂化学预防作用的理解。
