Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland.
Cancer Epidemiol Biomarkers Prev. 2019 Mar;28(3):563-569. doi: 10.1158/1055-9965.EPI-18-0965. Epub 2018 Nov 28.
NSAIDs appear to moderately reduce prostate cancer risk. However, evidence is limited on whether NSAIDs protect against prostate cancer mortality (death from prostate cancer among men without a cancer history) and case fatality (death from prostate cancer among men with prostate cancer), and whether benefits are consistent in white and black men. This study investigated associations of aspirin and non-aspirin (NA) NSAID use with prostate cancer incidence, mortality, and case fatality in a population-based cohort of white and black men.
We included 6,594 men (5,060 white and 1,534 black) from the Atherosclerosis Risk in Communities study without a cancer history at enrollment from 1987 to 1989. NSAID use was assessed at four study visits (1987-1998). Cancer outcomes were ascertained through 2012. Cox proportional hazards regression was used to estimate adjusted HRs, overall and by race.
Aspirin use was not associated with prostate cancer incidence. However, aspirin use was inversely associated with prostate cancer mortality [HR, 0.59; 95% confidence interval (CI), 0.36-0.96]. This association was consistent among white and black men and appeared restricted to men using aspirin daily and/or for cardiovascular disease prevention. Aspirin use was inversely associated with case fatality (HR, 0.45; 95% CI, 0.22-0.94). NA-NSAID use was not associated with these endpoints.
Aspirin use was inversely associated with prostate cancer mortality and case fatality among white and black men.
If confirmed by additional studies, benefits of aspirin for preventing prostate cancer mortality may need to be factored into risk-benefit calculations of men considering an aspirin regimen.
非甾体抗炎药（NSAIDs）似乎可适度降低前列腺癌风险。然而，目前关于 NSAIDs 是否能预防前列腺癌死亡率（无癌症病史男性的前列腺癌死亡）和病死率（前列腺癌男性的前列腺癌死亡），以及在白人和黑人男性中获益是否一致，证据有限。本研究在一个基于人群的白人和黑人男性队列中，调查了阿司匹林和非阿司匹林（非阿司匹林）NSAID 使用与前列腺癌发病、死亡和病死率的相关性。
我们纳入了 1987 年至 1989 年无癌症病史的动脉粥样硬化风险社区研究中的 6594 名男性（5060 名白人，1534 名黑人）。在四次研究访视中（1987-1998 年）评估 NSAID 使用情况。通过 2012 年的癌症结局确定。使用 Cox 比例风险回归估计调整后的 HR，整体和按种族。
阿司匹林使用与前列腺癌发病无关。然而，阿司匹林的使用与前列腺癌死亡率呈负相关[HR，0.59；95%置信区间（CI），0.36-0.96]。这种相关性在白人和黑人男性中是一致的，并且似乎仅限于每天使用阿司匹林和/或用于心血管疾病预防的男性。阿司匹林的使用与病死率呈负相关（HR，0.45；95%CI，0.22-0.94）。非阿司匹林 NSAID 的使用与这些终点无关。
阿司匹林的使用与白人和黑人男性的前列腺癌死亡率和病死率呈负相关。
如果其他研究证实了这一结果，那么在考虑阿司匹林方案的男性中，预防前列腺癌死亡率的阿司匹林益处可能需要纳入风险效益计算。
