阿司匹林用于预防癌症发病率和死亡率：美国预防服务工作组的系统证据评价。

Aspirin for the Prevention of Cancer Incidence and Mortality: Systematic Evidence Reviews for the U.S. Preventive Services Task Force.

出版信息

Ann Intern Med. 2016 Jun 21;164(12):814-25. doi: 10.7326/M15-2117. Epub 2016 Apr 12.

DOI:10.7326/M15-2117

PMID:27064482

Abstract

BACKGROUND

Cancer is the second leading cause of death in the United States.

PURPOSE

To conduct systematic reviews of aspirin and 1) total cancer mortality and incidence in persons eligible for primary prevention of cardiovascular disease (CVD) and 2) colorectal cancer (CRC) mortality and incidence in persons at average CRC risk.

DATA SOURCES

MEDLINE, PubMed, and the Cochrane Central Register of Controlled Trials through January 2015 and relevant references from other reviews.

STUDY SELECTION

Trials comparing oral aspirin versus placebo or no treatment in adults aged 40 years or older were included. Two investigators independently reviewed abstracts and articles against inclusion and quality criteria.

DATA EXTRACTION

Data from 20 good- or fair-quality trials were abstracted by one reviewer and checked by another.

DATA SYNTHESIS

In CVD primary prevention trials, cancer mortality (relative risk [RR], 0.96 [95% CI, 0.87 to 1.06]) (10 trials; n = 103 787) and incidence (RR, 0.98 [CI, 0.93 to 1.04]) (6 trials; n = 72 926) were similar in aspirin and control groups over 3.6 to 10.1 years. In CVD primary and secondary prevention trials, 20-year CRC mortality was reduced among persons assigned to aspirin therapy (RR, 0.67 [CI, 0.52 to 0.86]) (4 trials; n = 14 033). Aspirin appeared to reduce CRC incidence beginning 10 to 19 years after initiation (RR, 0.60 [CI, 0.47 to 0.76]) (3 trials; n = 47 464).

LIMITATIONS

Most data were from clinically and methodologically heterogeneous CVD prevention trials. Outcome assessment and follow-up length varied across studies. Data on non-CRC cancer types and subgroups were limited.

CONCLUSION

In CVD primary prevention populations, aspirin's effect on total cancer mortality and incidence was not clearly established. Evidence from CVD primary and secondary prevention studies suggested that aspirin therapy reduces CRC incidence and perhaps mortality approximately 10 years after initiation.

PRIMARY FUNDING SOURCE

Agency for Healthcare Research and Quality.

摘要

背景

癌症是美国的第二大死亡原因。

目的

对阿司匹林进行系统评价，1）评估适合心血管疾病（CVD）一级预防的人群中阿司匹林对总癌症死亡率和发病率的影响，2）评估阿司匹林对平均结直肠癌（CRC）风险人群中结直肠癌死亡率和发病率的影响。

数据来源

通过 2015 年 1 月的 MEDLINE、PubMed 和 Cochrane 对照试验中心注册库进行检索，并对其他综述的相关参考文献进行检索。

研究选择

纳入了比较口服阿司匹林与安慰剂或不治疗的成年人（年龄 40 岁或以上）的试验。两位研究者独立地对摘要和文章进行了纳入和质量标准的审查。

数据提取

一位研究者对 20 项高质量或中等质量的试验数据进行了提取，另一位研究者对其进行了核对。

数据综合

在 CVD 一级预防试验中，阿司匹林组与对照组相比，癌症死亡率（相对风险 [RR]，0.96 [95%CI，0.87 至 1.06]）（10 项试验；n=103787）和癌症发病率（RR，0.98 [CI，0.93 至 1.04]）（6 项试验；n=72926）在 3.6 至 10.1 年的随访中相似。在 CVD 一级和二级预防试验中，接受阿司匹林治疗的人群 20 年 CRC 死亡率降低（RR，0.67 [CI，0.52 至 0.86]）（4 项试验；n=14033）。阿司匹林似乎在开始治疗后 10 至 19 年内开始降低 CRC 的发病率（RR，0.60 [CI，0.47 至 0.76]）（3 项试验；n=47464）。