Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom.
Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom.
Gastroenterology. 2018 Mar;154(4):849-860.e1. doi: 10.1053/j.gastro.2017.10.044. Epub 2017 Nov 6.
BACKGROUND & AIMS: Preclinical studies have shown aspirin to have anticancer properties and epidemiologic studies have associated aspirin use with longer survival times of patients with cancer. We studied 2 large cohorts to determine the association between aspirin use and cancer-specific mortality in patients with esophageal or gastric cancer.
We performed a population-based study using cohorts of patients newly diagnosed with esophageal or gastric cancer, identified from cancer registries in England from 1998 through 2012 and the Scottish Cancer Registry from 2009 through 2012. Low-dose aspirin prescriptions were identified from linkages to the United Kingdom Clinical Research Practice Datalink in England and the Prescribing Information System in Scotland. Deaths were identified from linkage to national mortality records, with follow-up until September 2015 in England and January 2015 in Scotland. Time-dependent Cox regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for cancer-specific mortality by low-dose aspirin use after adjusting for potential confounders. Meta-analysis was used to pool results across the 2 cohorts.
The combined English and Scottish cohorts contained 4654 patients with esophageal cancer and 3833 patients with gastric cancer, including 3240 and 2392 cancer-specific deaths, respectively. The proportions surviving 1 year, based on cancer-specific mortality, were similar in aspirin users vs non-users after diagnosis with esophageal cancer (48% vs 50% in England and 49% vs 46% in Scotland, respectively) or gastric cancer (58% vs 57% in England and 59% vs 55% in Scotland, respectively). There was no association between postdiagnosis use of low-dose aspirin and cancer-specific mortality among patients with esophageal cancer (pooled adjusted HR, 0.98; 95% CI, 0.89-1.09) or gastric cancer (pooled adjusted HR, 0.96; 95% CI, 0.85-1.08). Long-term aspirin use was not associated with cancer-specific mortality after diagnosis of esophageal cancer (pooled adjusted HR, 1.03; 95% CI, 0.85-1.25) or gastric cancer (pooled adjusted HR, 1.06; 95% CI, 0.85-1.32).
In analyses of 2 large independent cohorts in the United Kingdom, low-dose aspirin usage was not associated with increased survival of patients diagnosed with esophageal or gastric cancer.
临床前研究表明阿司匹林具有抗癌特性，流行病学研究表明阿司匹林的使用与癌症患者的生存时间延长有关。我们研究了两个大队列，以确定阿司匹林的使用与食管或胃癌患者的癌症特异性死亡率之间的关系。
我们使用从 1998 年至 2012 年在英格兰癌症登记处和 2009 年至 2012 年在苏格兰癌症登记处新诊断为食管或胃癌的患者队列进行了一项基于人群的研究。通过与英格兰的英国临床研究实践数据链接和苏格兰的处方信息系统的链接来确定低剂量阿司匹林的处方。通过与国家死亡率记录的链接来确定死亡情况，在英格兰的随访截止到 2015 年 9 月，在苏格兰的随访截止到 2015 年 1 月。使用时间依赖性 Cox 回归模型来计算癌症特异性死亡率的风险比（HR）和 95％置信区间（CI），在调整了潜在混杂因素后，根据低剂量阿司匹林的使用情况进行计算。使用荟萃分析来汇总两个队列的结果。
英格兰和苏格兰的联合队列包含 4654 名食管癌症患者和 3833 名胃癌症患者，其中分别有 3240 例和 2392 例癌症特异性死亡。根据癌症特异性死亡率，在诊断为食管或胃癌后，阿司匹林使用者和非使用者的 1 年生存率相似（英格兰分别为 48％和 50％，苏格兰分别为 49％和 46％）。在诊断后使用低剂量阿司匹林与食管癌（合并调整后的 HR，0.98；95％CI，0.89-1.09）或胃癌（合并调整后的 HR，0.96；95％CI，0.85-1.08）患者的癌症特异性死亡率之间没有关联。长期使用阿司匹林与诊断为食管癌后（合并调整后的 HR，1.03；95％CI，0.85-1.25）或胃癌（合并调整后的 HR，1.06；95％CI，0.85-1.32）的癌症特异性死亡率无关。
在对英国的两个独立大型队列的分析中，低剂量阿司匹林的使用与诊断为食管或胃癌患者的生存改善无关。
