Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong.
J Natl Cancer Inst. 2018 Jul 1;110(7):743-749. doi: 10.1093/jnci/djx267.
Despite successful H. pylori (HP) eradication, some individuals remain at risk of developing gastric cancer (GC). Previous studies showed that aspirin was associated with a reduced GC risk. However, whether aspirin can reduce GC risk in HP-eradicated subjects remains unknown. We aimed to determine the chemopreventive effect of aspirin in HP-eradicated subjects.
We identified subjects who had received a prescription of clarithromycin-based triple therapy for HP between 2003 and 2012 from a territory-wide health care database. The observation period started from commencement of HP therapy (index date), and the follow-up was censored at the end of the study (December 2015), death, or GC diagnosis. Aspirin use was defined as use once or more often weekly. Subjects who failed HP eradication or were diagnosed with GC within 12 months of HP therapy were excluded. The hazard ratio (HR) of GC with aspirin use was calculated by Cox model with Propensity Score adjustment for age, sex, comorbidities, and concurrent medications. All statistical tests were two-sided.
The median follow-up was 7.6 years (interquartile range [IQR] = 5.1-10.3 years), and 169 (0.27%) out of 63 605 patients developed GC. The incidence rate of GC was 3.5 per 10 000 person-years. Aspirin use was associated with a reduced GC risk (HR = 0.30, 95% confidence interval [CI] = 0.15 to 0.61). The risk of GC decreased with increasing frequency, duration, and dose of aspirin (all Ptrend < .001).
Aspirin use was associated with a frequency-, dose-, and duration-dependent reduction in GC risk after HP eradication. The effect was most prominent in those who used aspirin daily or for five or more years.
尽管幽门螺杆菌（HP）根除成功，但仍有部分个体存在发生胃癌（GC）的风险。既往研究显示，阿司匹林与降低 GC 风险相关。然而，在 HP 根除的患者中，阿司匹林是否能降低 GC 风险仍不清楚。我们旨在确定阿司匹林在 HP 根除患者中的化学预防作用。
我们从一个全港医疗数据库中确定了 2003 年至 2012 年间接受克拉霉素三联疗法治疗 HP 的患者。观察期从开始进行 HP 治疗（索引日期）开始，随访截止于研究结束（2015 年 12 月）、死亡或 GC 诊断。阿司匹林的使用定义为每周使用一次或更多次。排除 HP 根除失败或在 HP 治疗后 12 个月内诊断为 GC 的患者。使用 Cox 模型并通过倾向评分调整年龄、性别、合并症和同时使用的药物来计算使用阿司匹林的 GC 风险比（HR）。所有统计检验均为双侧。
中位随访时间为 7.6 年（四分位间距 [IQR] = 5.1-10.3 年），63605 例患者中有 169 例（0.27%）发生 GC。GC 的发病率为每 10000 人年 3.5 例。阿司匹林的使用与降低 GC 风险相关（HR=0.30，95%置信区间 [CI] = 0.15 至 0.61）。随着阿司匹林使用频率、时长和剂量的增加，GC 的风险降低（所有 Ptrend<0.001）。
在 HP 根除后，阿司匹林的使用与 GC 风险的频率、剂量和时长依赖性降低相关。在每日或使用 5 年或以上的患者中，效果最为显著。
