Department of Family Medicine, Gachon University Gil Medical Center, Incheon, 405-760, Republic of Korea.
Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, 03080, Republic of Korea.
Sci Rep. 2018 Mar 21;8(1):4968. doi: 10.1038/s41598-018-23343-0.
The effect of aspirin on the risk of hepatocellular carcinoma (HCC) remains unclear. We investigated the association between aspirin use and HCC development in a region where viral hepatitis prevails. We conducted a population-based cohort study including a total of 460,755 participants who were tracked to identify incidents of HCC since 2007. The use of drug before the index date was assessed and standardized by the Defined Daily Dose system. We calculated the hazard ratios (HRs) and their 95% confidence intervals (CIs) for the association between aspirin use and HCC occurrence, using Cox proportional hazard regression models. There were 2,336 cases of HCC during the period of 2,965,500 person-years. Overall, aspirin users had a lower HCC risk (HR, 0.87; 95% CI, 0.77-0.98) than non-users in a dose-response manner (P = 0.002). The protective effect of aspirin was amplified when combined with those of non-aspirin non-steroidal anti-inflammatory drugs (HR, 0.65; 95% CI, 0.50-0.85). Subgroup analyses revealed a significant chemopreventive effect of aspirin in individuals who were young, were male, or had viral hepatitis, whereas no protective effect was observed in patients with liver cirrhosis. Our results, suggesting different carcinogenic pathways between viral and non-viral etiologies, may validate the design of future intervention trials of aspirin for HCC prevention in eligible populations.
阿司匹林对肝细胞癌（HCC）风险的影响尚不清楚。我们在一个病毒性肝炎流行的地区，调查了阿司匹林使用与 HCC 发展之间的关系。我们进行了一项基于人群的队列研究，共纳入了 460755 名参与者，自 2007 年以来对他们进行了 HCC 发病情况的跟踪。使用药物前的使用情况通过定义日剂量系统进行评估和标准化。我们使用 Cox 比例风险回归模型计算了阿司匹林使用与 HCC 发生之间的关联的风险比（HR）及其 95%置信区间（CI）。在 2965500 人年期间，共发生了 2336 例 HCC。总体而言，阿司匹林使用者的 HCC 风险低于非使用者（HR，0.87；95%CI，0.77-0.98），呈剂量反应关系（P=0.002）。当与非阿司匹林非甾体抗炎药联合使用时，阿司匹林的保护作用更为显著（HR，0.65；95%CI，0.50-0.85）。亚组分析显示，阿司匹林对年轻、男性或患有病毒性肝炎的个体具有显著的化学预防作用，而在肝硬化患者中未观察到保护作用。我们的结果表明，病毒和非病毒病因之间存在不同的致癌途径，这可能为未来在合适人群中进行阿司匹林预防 HCC 的干预试验设计提供依据。
