非甾体抗炎药与根治性肝切除术后早期肝细胞癌复发风险降低相关：一项全国性队列研究。
Nonsteroidal anti-inflammatory drugs are associated with reduced risk of early hepatocellular carcinoma recurrence after curative liver resection: a nationwide cohort study.
机构信息
*Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan †Department of Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan ‡School of Medicine, China Medical University, Taichung, Taiwan §School of Medicine, Fu Jen Catholic University, Taipei, Taiwan ¶Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan ‖Center for Health Policy Research and Development, National Health Research Institutes, Miaoli, Taiwan **Division of Gastroenterology, National Taiwan University Hospital, Taipei, Taiwan ††Center for Evidence-Based Medicine Taipei Medical University, Taipei, Taiwan ‡‡Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan §§Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan ¶¶Department of Public Health, China Medical University, Taichung, Taiwan; and ‖‖Department of Life Sciences, National Chung-Hsing University, Taichung, Taiwan.
出版信息
Ann Surg. 2015 Mar;261(3):521-6. doi: 10.1097/SLA.0000000000000746.
PURPOSE
The efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) in reducing the risk of various de novo cancers has been reported; however, its role in reducing hepatocellular carcinoma (HCC) recurrence after liver resection still remains unknown.
METHODS
We have conducted a nationwide cohort study by recruiting all patients with a newly diagnosed HCC who had received curative liver resection as their initial treatment. The use of NSAIDs and the risk of early HCC recurrence have been examined by multivariate and stratified analyses. To avoid immortal time bias, the use of NSAIDs has been treated as a time-dependent variable in Cox proportional hazard ratio models.
RESULTS
Between January 1997 and December 2010, a total of 15,574 HCC patients who had received liver resection were enrolled in this study. The 1-, 3-, and 5-year overall survival rates were 90.4%, 73.2%, and 59.8%, respectively. The 1-, 3-, and 5-year disease-free survival rates were 80.5%, 59.4%, and 50.2%, respectively. NSAID use (hazard ratio, 0.81; 95% confidence interval, 0.73-0.90) and minor liver resection (hazard ratio, 0.83; 95% confidence interval, 0.78-0.89) were independently associated with a reduced risk of early HCC recurrence after liver resection. In the stratified analyses, NSAID usage was universally associated with reduced risks in most subgroups, particularly for those aged younger than 65 years, male, with underlying diabetes mellitus and receiving major liver resection.
CONCLUSIONS
The use of NSAIDs can be associated with a reduced risk of early HCC recurrence within 2 years after curative liver resection, regardless of patients' age, extent of liver resection, viral hepatitis status, underlying diabetes, and liver cirrhosis.
目的
已报道非甾体抗炎药（NSAIDs）在降低各种新发癌症风险方面的疗效；然而，其在降低肝癌（HCC）切除术后复发风险方面的作用仍不清楚。
方法
我们通过招募所有接受根治性肝切除术作为初始治疗的新诊断 HCC 患者，进行了一项全国性队列研究。通过多变量和分层分析检查 NSAIDs 的使用与早期 HCC 复发风险之间的关系。为避免 Immortal time bias，在 Cox 比例风险比模型中，将 NSAIDs 的使用视为一个时依变量。
结果
1997 年 1 月至 2010 年 12 月，共纳入 15574 例接受肝切除术的 HCC 患者。1、3、5 年总生存率分别为 90.4%、73.2%和 59.8%。1、3、5 年无病生存率分别为 80.5%、59.4%和 50.2%。NSAID 使用（风险比，0.81；95%置信区间，0.73-0.90）和小范围肝切除术（风险比，0.83；95%置信区间，0.78-0.89）与肝切除术后早期 HCC 复发风险降低独立相关。在分层分析中，NSAID 使用与大多数亚组的 HCC 复发风险降低相关，尤其是在年龄小于 65 岁、男性、患有基础糖尿病和接受大范围肝切除术的患者中。
结论
在根治性肝切除术后 2 年内，使用 NSAIDs 与降低早期 HCC 复发风险相关，无论患者年龄、肝切除范围、乙型肝炎病毒感染状态、基础糖尿病和肝硬化状况如何。
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