Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.
Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark.
Gynecol Oncol. 2018 Aug;150(2):331-337. doi: 10.1016/j.ygyno.2018.06.018. Epub 2018 Jun 28.
Preclinical studies suggest that non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs) may improve survival of ovarian cancer. We examined the association between non-aspirin NSAID use and ovarian cancer mortality.
All women in Denmark with a first diagnosis of epithelial ovarian cancer between 2000 and 2012 were identified. We obtained information on drug use, mortality outcomes, and potential confounding factors from nationwide registries. Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between postdiagnosis non-aspirin NSAID use (≥1 prescription) and ovarian cancer-specific or other-cause mortality compared with non-use (no prescriptions). The influence of competing risks was evaluated using the sub-distribution hazards model proposed by Fine and Gray.
Among 4117 patients, any postdiagnosis use of non-aspirin NSAIDs was not associated with either ovarian cancer (HR = 0.97, 95% CI = 0.87-1.08) or other-cause (HR = 0.99, 95% CI = 0.77-1.27) mortality, however, inverse associations for ovarian cancer mortality were observed with high cumulative (HR = 0.75, 95% CI = 0.60-0.94) or high-intensity (HR = 0.86, 95% CI = 0.72-1.03) postdiagnosis use of non-aspirin NSAIDs. The associations differed substantially with histological subtype of ovarian cancer, with only inverse associations observed for serous ovarian cancer (HR = 0.87, 95% CI = 0.77-0.99). Among a smaller number of patients with a non-serous tumor, postdiagnosis non-aspirin NSAID use was associated with increased ovarian cancer mortality.
Any postdiagnosis use of non-aspirin NSAIDs did not influence ovarian cancer mortality overall, however, more intensive use was associated with improved survival of serous ovarian cancer.
临床前研究表明，非阿司匹林类非甾体抗炎药（NSAIDs）可能改善卵巢癌患者的生存。我们研究了非阿司匹林类 NSAID 使用与卵巢癌死亡率之间的关系。
在丹麦，所有在 2000 年至 2012 年间首次诊断为上皮性卵巢癌的女性均被纳入研究。我们从全国性登记处获得了药物使用、死亡率结果和潜在混杂因素的信息。使用 Cox 回归模型估计了与非使用（无处方）相比，诊断后使用非阿司匹林类 NSAID（≥1 个处方）与卵巢癌特异性或其他原因死亡率之间的风险比（HR）和 95%置信区间（CI）。使用 Fine 和 Gray 提出的亚分布风险模型评估了竞争风险的影响。
在 4117 名患者中，任何诊断后使用非阿司匹林类 NSAID 均与卵巢癌（HR=0.97，95%CI=0.87-1.08）或其他原因（HR=0.99，95%CI=0.77-1.27）死亡率无关，然而，对于卵巢癌死亡率，高累积（HR=0.75，95%CI=0.60-0.94）或高强度（HR=0.86，95%CI=0.72-1.03）诊断后使用非阿司匹林类 NSAID 与卵巢癌死亡率呈负相关。这些关联在卵巢癌的组织学亚型上存在显著差异，只有浆液性卵巢癌（HR=0.87，95%CI=0.77-0.99）观察到负相关。在少数非浆液性肿瘤患者中，诊断后非阿司匹林类 NSAID 的使用与卵巢癌死亡率增加相关。
任何诊断后使用非阿司匹林类 NSAID 均不会影响总体卵巢癌死亡率，然而，更密集的使用与改善浆液性卵巢癌的生存有关。
