Cronin-Fenton Deirdre P, Heide-Jørgensen Uffe, Ahern Thomas P, Lash Timothy L, Christiansen Peer, Ejlertsen Bent, Sørensen Henrik T
From the aDepartment of Clinical Epidemiology, Aarhus University, Aarhus, Denmark; bDepartments of Surgery and Biochemistry, University of Vermont, Burlington, VT; cDepartment of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA; dBreast and Endocrine Section, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark; eDanish Breast Cancer Cooperative Group, Copenhagen, Denmark; and fRigshospitalet, Copenhagen, Denmark.
Epidemiology. 2016 Jul;27(4):586-93. doi: 10.1097/EDE.0000000000000480.
Aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and selective COX-2 inhibitors may improve outcomes in breast cancer patients. We investigated the association of aspirin, NSAIDs, and use of selective COX-2 inhibitors with breast cancer recurrence.
We identified incident stage I-III Danish breast cancer patients in the Danish Breast Cancer Cooperative Group registry, who were diagnosed during 1996-2008. Prescriptions for aspirin (>99% low-dose aspirin), NSAIDs, and selective COX-2 inhibitors were ascertained from the National Prescription Registry. Follow-up began on the date of breast cancer primary surgery and continued until the first of recurrence, death, emigration, or 1 January 2013. We used Cox regression models to compute hazard ratios (HR) and corresponding 95% confidence intervals (95% CI) associating prescriptions with recurrence, adjusting for confounders.
We identified 34,188 breast cancer patients with 233,130 person-years of follow-up. Median follow-up was 7.1 years; 5,325 patients developed recurrent disease. Use of aspirin, NSAIDs, or selective COX-2 inhibitors was not associated with the rate of recurrence (HRadjusted aspirin = 1.0, 95% CI = 0.90, 1.1; NSAIDs = 0.99, 95% CI = 0.92, 1.1; selective COX-2 inhibitors = 1.1, 95% CI = 0.98, 1.2), relative to nonuse. Prediagnostic use of the exposure drugs was associated with reduced recurrence rates (HRaspirin = 0.92, 95% CI = 0.82, 1.0; HRNSAIDs = 0.86, 95% CI = 0.81, 0.91; HRsCOX-2inhibitors = 0.88, 95% CI = 0.83, 0.95).
This prospective cohort study suggests that post diagnostic prescriptions for aspirin, NSAIDs, and selective COX-2 inhibitors have little or no association with the rate of breast cancer recurrence. Prediagnostic use of the drugs was, however, associated with a reduced rate of breast cancer recurrence.
阿司匹林、非甾体抗炎药（NSAIDs）和选择性环氧化酶-2（COX-2）抑制剂可能改善乳腺癌患者的预后。我们研究了阿司匹林、NSAIDs以及选择性COX-2抑制剂的使用与乳腺癌复发之间的关联。
我们在丹麦乳腺癌合作组登记处中确定了1996年至2008年期间确诊的I-III期丹麦乳腺癌初发患者。从国家处方登记处确定阿司匹林（>99%为低剂量阿司匹林）、NSAIDs和选择性COX-2抑制剂的处方。随访从乳腺癌初次手术日期开始，持续至首次复发、死亡、移民或2013年1月1日。我们使用Cox回归模型计算与复发相关的风险比（HR）及相应的95%置信区间（95%CI），并对混杂因素进行校正。
我们确定了34188例乳腺癌患者，随访时间共计233130人年。中位随访时间为7.1年；5325例患者出现疾病复发。与未使用相比，使用阿司匹林、NSAIDs或选择性COX-2抑制剂与复发率无关（校正后阿司匹林的HR = 1.0，95%CI = 0.90，1.1；NSAIDs = 0.99，95%CI = 0.92，1.1；选择性COX-2抑制剂 = 1.1，95%CI = 0.98，1.2）。诊断前使用这些暴露药物与复发率降低相关（阿司匹林的HR = 0.92，95%CI = 0.82，1.0；NSAIDs的HR = 0.86，95%CI = 0.81，0.91；COX-2抑制剂的HR = （此处原文有误，应为选择性COX-2抑制剂）0.88，95%CI = 0.83，0.95）。
这项前瞻性队列研究表明，诊断后使用阿司匹林、NSAIDs和选择性COX-2抑制剂开具的处方与乳腺癌复发率几乎没有关联或无关联。然而，诊断前使用这些药物与乳腺癌复发率降低相关。
