Tao Yuquan, Li Yesheng, Liu Xing, Deng Qing, Yu Yongchun, Yang Zongguo
Department of Central Laboratory Medicine, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, China,
Department of Hepatobiliary Surgery, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China.
Cancer Manag Res. 2018 Aug 15;10:2695-2709. doi: 10.2147/CMAR.S167560. eCollection 2018.
The roles of nonsteroidal anti-inflammatory drugs (NSAIDs) in the occurrence and prognosis of hepatocellular carcinoma (HCC) remain controversial. This analysis aimed to summarize the relationships between NSAIDs and HCC development.
Studies published prior to October 1, 2017, in the PubMed, Embase, Ovid, Web of Science, and Cochrane Library databases were systematically searched and analyzed.
Eleven studies were included in this analysis. A meta-analysis of five studies revealed that aspirin use could significantly decrease the risk of HCC occurrence (hazards ratio [HR] = 0.64, 95% confidence interval [CI] = 0.45-0.91, = 0.014). No significant difference was found for the use of NSAIDs (six studies) and non-aspirin NSAIDs (three studies) in HCC occurrence (HR = 0.74, 95%CI = 0.53-1.02, = 0.064 and HR = 0.98, 95%CI = 0.87-1.12, = 0.81, respectively). However, subgroup analysis of cohort studies demonstrated that NSAIDs significantly decreased the risk of HCC occurrence (HR = 0.58, 95%CI = 0.43-0.78, < 0.001). HCC patients who received NSAIDs achieved better disease-free survival and overall survival compared with the non-NSAID users (HR = 0.79, 95%CI = 0.74-0.84, <0.001 and HR = 0.60, 95%CI = 0.50-0.72, <0.001, respectively). Additionally, a meta-analysis of two studies showed that aspirin treatment in HCC patients could significantly decrease the 2-year and 4-year mortalities (rate ratio [RR] = 0.50, 95%CI = 0.36-0.69, < 0.001 and RR = 0.67, 95%CI = 0.45-0.998, = 0.049, respectively). A meta-analysis of two studies showed that aspirin use was not associated with a higher risk of bleeding in HCC patients (HR = 0.71, 95%CI = 0.41-1.23, = 0.223).
The use of NSAIDs, especially aspirin, is linked to a lower risk of HCC development and better survival in HCC populations. High-quality, well-designed trials should be conducted to reevaluate the relationships between NSAIDs and HCC.
非甾体抗炎药（NSAIDs）在肝细胞癌（HCC）发生及预后中的作用仍存在争议。本分析旨在总结NSAIDs与HCC发生之间的关系。
系统检索并分析2017年10月1日前发表于PubMed、Embase、Ovid、Web of Science及Cochrane图书馆数据库中的研究。
本分析纳入11项研究。五项研究的荟萃分析显示，使用阿司匹林可显著降低HCC发生风险（风险比[HR]=0.64，95%置信区间[CI]=0.45 - 0.91，P=0.014）。在HCC发生方面，使用NSAIDs（六项研究）和非阿司匹林类NSAIDs（三项研究）未发现显著差异（HR分别为0.74，95%CI=0.53 - 1.02，P=0.064；HR=0.98，95%CI=0.87 - 1.12，P=0.81）。然而，队列研究的亚组分析表明，NSAIDs可显著降低HCC发生风险（HR=0.58，95%CI=0.43 - 0.78，P<0.001）。与未使用NSAIDs的患者相比，使用NSAIDs的HCC患者无病生存期和总生存期更佳（HR分别为0.79，95%CI=0.74 - 0.84，P<0.001；HR=0.60，95%CI=0.50 - 0.72，P<0.001）。此外，两项研究的荟萃分析显示，HCC患者使用阿司匹林治疗可显著降低2年和4年死亡率（率比[RR]分别为0.50，95%CI=0.36 - 0.69，P<0.001；RR=0.67，95%CI=0.45 - 0.998，P=0.049）。两项研究的荟萃分析显示，HCC患者使用阿司匹林与更高的出血风险无关（HR=0.71，95%CI=0.41 - 1.23，P=0.223）。
使用NSAIDs，尤其是阿司匹林，与HCC人群中较低的HCC发生风险及更好的生存率相关。应开展高质量、设计良好的试验以重新评估NSAIDs与HCC之间的关系。
