Wang Tengteng, Parada Humberto, McClain Kathleen M, Bradshaw Patrick T, Terry Mary Beth, Teitelbaum Susan L, Neugut Alfred I, Gammon Marilie D
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27599, USA.
Department of Epidemiology, UNC, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC, 27599-7435, USA.
Cancer Causes Control. 2018 May;29(4-5):417-425. doi: 10.1007/s10552-018-1020-5. Epub 2018 Mar 7.
Whether aspirin or other nonsteroidal anti-inflammation drug (NSAID) use is associated with mortality following breast cancer remains unclear. Consideration of use patterns and interaction with obesity may help to clarify the inconsistent results.
Pre-diagnosis NSAID use, weight, and height were assessed ~ 3 months after diagnosis through in-person interviews with a population-based cohort of 1,442 women with first primary breast cancer. Vital status was determined through the national death index after ~ 18 years of follow-up (N = 237/597 breast cancer-specific/all-cause deaths). We used Cox proportional hazards regression to estimate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). Multiplicative interaction by body mass index (BMI) was evaluated using the likelihood ratio test.
Ever aspirin use was inversely associated with breast cancer-specific mortality (HR 0.87, 95% CI 0.59-1.29), but positively associated with all-cause mortality (HR 1.21, 95% CI 0.99-1.48); the CIs included the null values. The HRs, however, were more pronounced for the highest level of duration, frequency, regularity, and timing for all-cause, but not breast cancer-specific mortality. Interactions with BMI revealed no significant heterogeneity (p = 0.37 and p = 0.36, respectively).
Pre-diagnosis aspirin use was not strongly associated with mortality following breast cancer. The all-cause mortality associations, however, were slightly stronger when we considered patterns of use.
阿司匹林或其他非甾体抗炎药（NSAID）的使用是否与乳腺癌患者的死亡率相关尚不清楚。考虑使用模式以及与肥胖的相互作用可能有助于阐明不一致的结果。
在诊断后约3个月，通过对1442例原发性乳腺癌女性的人群队列进行面对面访谈，评估诊断前NSAID的使用情况、体重和身高。经过约18年的随访（N = 237/597例乳腺癌特异性/全因死亡），通过国家死亡指数确定生命状态。我们使用Cox比例风险回归来估计多变量调整后的风险比（HR）和95%置信区间（CI）。使用似然比检验评估体重指数（BMI）的乘法相互作用。
曾经使用阿司匹林与乳腺癌特异性死亡率呈负相关（HR 0.87，95% CI 0.59 - 1.29），但与全因死亡率呈正相关（HR 1.21，95% CI 0.99 - 1.48）；CI包括无效值。然而，对于全因死亡率而非乳腺癌特异性死亡率，HR在持续时间、频率、规律性和时间的最高水平上更为明显。与BMI的相互作用未显示出显著的异质性（分别为p = 0.37和p = 0.36）。
诊断前使用阿司匹林与乳腺癌后的死亡率没有强烈关联。然而，当我们考虑使用模式时，全因死亡率的关联略强。
