低剂量阿司匹林或非甾体抗炎药使用与结直肠癌风险：一项基于人群的病例对照研究。

Low-Dose Aspirin or Nonsteroidal Anti-inflammatory Drug Use and Colorectal Cancer Risk: A Population-Based, Case-Control Study.

出版信息

Ann Intern Med. 2015 Sep 1;163(5):347-55. doi: 10.7326/M15-0039.

Abstract

BACKGROUND

A recent comprehensive review concluded that additional research is needed to determine the optimal use of aspirin for cancer prevention.

OBJECTIVE

To assess associations between the use of low-dose aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) and colorectal cancer risk.

DESIGN

Population-based, case-control study.

SETTING

Northern Denmark.

PATIENTS

Patients with first-time colorectal cancer in northern Denmark between 1994 and 2011. Population control participants were selected by risk set sampling.

MEASUREMENTS

Data on drug use, comorbid conditions, and history of colonoscopy were obtained from prescription and patient registries. Use of low-dose aspirin (75 to 150 mg) and nonaspirin NSAIDs was defined according to type, estimated dose, duration, and consistency of use.

RESULTS

Among 10 280 case patients and 102 800 control participants, the adjusted odds ratios (ORs) for colorectal cancer associated with ever use (≥2 prescriptions) of low-dose aspirin and nonaspirin NSAIDs were 1.03 (95% CI, 0.98 to 1.09) and 0.94 (CI, 0.90 to 0.98), respectively. Continuous long-term use (≥5 years) of low-dose aspirin was associated with a 27% reduction in colorectal cancer risk (OR, 0.73 [CI, 0.54 to 0.99]), whereas the overall OR for cumulative long-term use (continuous or noncontinuous) was close to unity. Nonaspirin NSAID use was associated with a substantial reduction in colorectal cancer risk, particularly for long-term, high-intensity use (average defined daily dose ≥0.3) of agents with high cyclooxygenase-2 selectivity (OR, 0.57 [CI, 0.44 to 0.74]).

LIMITATIONS

Data were unavailable on over-the-counter purchases of high-dose aspirin and low-dose ibuprofen or NSAID dosing schedules, there were several comparisons, and the authors were unable to adjust for confounding by some risk factors.

CONCLUSION

Long-term, continuous use of low-dose aspirin and long-term use of nonaspirin NSAIDs were associated with reduced colorectal cancer risk. Persons who continuously used low-dose aspirin comprised only a small proportion of the low-dose aspirin users.

PRIMARY FUNDING SOURCE

Danish Cancer Society, Aarhus University Research Foundation.

摘要

背景

最近的一项全面综述得出结论，需要进一步研究来确定阿司匹林在癌症预防方面的最佳使用方法。

目的

评估低剂量阿司匹林或其他非甾体抗炎药（NSAIDs）的使用与结直肠癌风险之间的关联。

设计

基于人群的病例对照研究。

设置

丹麦北部。

患者

1994 年至 2011 年间在丹麦北部首次诊断患有结直肠癌的患者。通过风险集抽样选择了人群对照参与者。

测量方法

从处方和患者登记处获取有关药物使用、合并症和结肠镜检查史的数据。根据类型、估计剂量、持续时间和使用一致性确定低剂量阿司匹林（75 至 150mg）和非阿司匹林 NSAIDs 的使用情况。

结果

在 10280 例病例患者和 102800 例对照参与者中，与使用（≥2 份处方）低剂量阿司匹林和非阿司匹林 NSAIDs 相关的结直肠癌调整后比值比（OR）分别为 1.03（95%CI，0.98 至 1.09）和 0.94（CI，0.90 至 0.98）。长期连续使用（≥5 年）低剂量阿司匹林与结直肠癌风险降低 27%相关（OR，0.73 [CI，0.54 至 0.99]），而累积长期使用（连续或非连续）的总体 OR 接近 1。非阿司匹林 NSAID 使用与结直肠癌风险显著降低相关，特别是对于长期、高强度使用（平均定义日剂量≥0.3）高环氧化酶-2选择性药物（OR，0.57 [CI，0.44 至 0.74]）。