Department of Internal Medicine, Albert Einstein Medical Center, PA, USA.
Department of Nephrology, Mayo Clinic, Nephrology and Hypertension, Rochester, MN, USA.
QJM. 2019 Jun 1;112(6):421-427. doi: 10.1093/qjmed/hcz039.
Non-steroidal anti-inflammatory drugs (NSAIDs) can suppress the proliferation of cholangiocarcinoma (CCA) cells in vitro through inhibition of cyclooxygenase-2. However, the effects of aspirin and NSAIDs on the risk of CCA remain unclear. We performed this meta-analysis to assess the risk of biliary tract cancers in patients who take aspirin and/or NSAIDs.
A systematic review was conducted utilizing MEDLINE, EMBASE, Cochrane databases from inception through October 2017 to identify studies that assessed the association of aspirin and/or NSAIDs use with risk of biliary tract cancers including CCA, gallbladder cancer and ampulla of Vater cancer. Effect estimates from the studies were extracted and combined using the random-effect, generic inverse variance method of DerSimonian and Laird.
Five observational studies with a total of 9 200 653 patients were enrolled. The pooled OR of CCA in patients with aspirin use was 0.56 (95% CI, 0.32-0.96). Egger's regression asymmetry test was performed and showed no publication bias for the association between aspirin use and CCA with P = 0.42. There was no significant association between NSAIDs use and CCA, with a pooled OR of 0.79 (95% CI, 0.28-2.21). One study showed a significant association between aspirin use and reduced risk of gallbladder cancer with OR of 0.37 (0.17-0.80). However, there was no significant association between aspirin and ampulla of Vater cancer with OR of 0.22 (0.03-1.65).
Our study demonstrates a significant association between aspirin use and a 0.56-fold decreased risk of CCA. However, there is no association between the use of NSAIDs and CCA.
非甾体抗炎药（NSAIDs）可通过抑制环氧化酶-2来抑制胆管癌（CCA）细胞的增殖。然而，阿司匹林和 NSAIDs 对 CCA 风险的影响仍不清楚。我们进行了这项荟萃分析，以评估服用阿司匹林和/或 NSAIDs 的患者发生胆道癌的风险。
我们通过 MEDLINE、EMBASE 和 Cochrane 数据库系统地检索了从建库至 2017 年 10 月的研究，以评估阿司匹林和/或 NSAIDs 使用与包括 CCA、胆囊癌和壶腹癌在内的胆道癌风险之间的关联。使用随机效应、通用倒数方差法对来自研究的效应估计值进行提取和合并。
共纳入了 5 项观察性研究，总计 9200653 名患者。阿司匹林使用者发生 CCA 的汇总 OR 为 0.56（95%CI，0.32-0.96）。Egger 回归不对称检验显示，阿司匹林使用与 CCA 之间的关联无发表偏倚，P = 0.42。NSAIDs 使用与 CCA 之间无显著关联，汇总 OR 为 0.79（95%CI，0.28-2.21）。一项研究显示，阿司匹林使用与胆囊癌风险降低显著相关，OR 为 0.37（0.17-0.80）。然而，阿司匹林与壶腹癌之间无显著关联，OR 为 0.22（0.03-1.65）。
我们的研究表明，阿司匹林使用与 CCA 风险降低 0.56 倍之间存在显著关联。然而，NSAIDs 使用与 CCA 之间无关联。
