Veitonmäki Thea, Murtola Teemu J, Määttänen Liisa, Taari Kimmo, Stenman Ulf-Håkan, Tammela Teuvo L J, Auvinen Anssi
Department of Urology, Tampere University Hospital, Tampere, Finland.
School of Health Sciences, University of Tampere, Tampere, Finland.
Prostate. 2015 Sep;75(13):1394-402. doi: 10.1002/pros.23020. Epub 2015 Jun 12.
Growing evidence suggests that aspirin is associated with decreased prostate cancer (PCa) mortality. The effect of other NSAID use on risk of PCa death remains controversial. We examined prostate cancer survival among aspirin and other NSAID users in the Finnish Prostate Cancer Screening Trial.
A total of 6,537 men were diagnosed with prostate cancer in 1996-2009 among the 80,144 men in the trial and 617 died from prostate cancer during the median follow-up of 7.5 years after the diagnosis. Prescription drug purchases information was obtained from the national reimbursement database. We calculated hazard ratios and 95% confidence intervals for PCa-specific survival using multivariable-adjusted Cox regression analysis separately for NSAID and aspirin usage before and after the diagnosis.
We observed an increased risk of PCa death associated with both pre- and post-diagnostic NSAID usage (HR 1.30, 95%CI 1.07-1.58 and HR 2.09, 95%CI 1.75-2.50, respectively). An increasing risk trend was observed by cumulative dose and intensity of NSAID use. When the last three years were excluded from the analysis, the death risk diminished to a protective level (HR 0.42, 95%CI 0.34-0.51 and HR 0.30 95%CI 0.24-0.39). Aspirin use was not significantly associated with prostate cancer survival.
The survival decrease among NSAID users is likely explained by symptomatic treatment of metastatic pain in patients with advanced PCa. However, results of the lag time analysis support previous findings of a possible preventative action of NSAIDs.
越来越多的证据表明，阿司匹林与前列腺癌（PCa）死亡率降低有关。使用其他非甾体抗炎药（NSAID）对PCa死亡风险的影响仍存在争议。我们在芬兰前列腺癌筛查试验中研究了阿司匹林和其他NSAID使用者的前列腺癌生存率。
在该试验的80144名男性中，共有6537名男性在1996年至2009年期间被诊断为前列腺癌，其中617人在诊断后的中位随访7.5年期间死于前列腺癌。处方药购买信息来自国家报销数据库。我们分别使用多变量调整的Cox回归分析，针对诊断前后的NSAID和阿司匹林使用情况，计算PCa特异性生存的风险比和95%置信区间。
我们观察到，诊断前和诊断后使用NSAID均与PCa死亡风险增加相关（风险比分别为1.30，95%置信区间为1.07 - 1.58；以及2.09，95%置信区间为1.75 - 2.50）。观察到NSAID使用的累积剂量和强度增加时风险呈上升趋势。当分析中排除最后三年时，死亡风险降至保护水平（风险比为0.42，95%置信区间为0.34 - 0.51；以及风险比为0.30，95%置信区间为0.24 - 0.39）。阿司匹林使用与前列腺癌生存无显著关联。
NSAID使用者生存率降低可能是由于晚期PCa患者转移性疼痛的对症治疗。然而，滞后时间分析结果支持了先前关于NSAIDs可能具有预防作用的发现。
