Department of Digital Health, Samsung Advanced Institute for Health Science and Technology, Sunkyunkwan University, Seoul, Korea.
Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Korea.
J Viral Hepat. 2020 Jan;27(1):68-73. doi: 10.1111/jvh.13201. Epub 2019 Oct 2.
The study aimed to investigate the relationship between the use of COX inhibitors and the risk of hepatocellular carcinoma (HCC) development in patients with chronic hepatitis B (CHB) using a nationwide population-based data. A nested case-control study was conducted using the National Health Insurance Service-National Sample Cohort (NHIS-NSC) from 2002 to 2013 in Korea. We compared the use of COX inhibitors between HCC cases and matched controls by categorizing 5 groups according to the cumulative defined daily dose (cDDD, <28, 28-90, 91-180, 181-360, and >360) adjusting the use of antiviral agents. A total of 4980 patients with CHB were analysed as 996 HCC cases and 3984 matched controls. The number of COX inhibitor users (≥28 cDDD) was 358 patients (36%) and 1814 patients (45%) in the HCC group and control group, respectively. The use of COX inhibitors was significantly associated with a decreased risk of HCC development compared with nonusers (adjusted odds ratio [OR] 0.62, 95% confidence interval [CI] 0.52-0.73, P < .001). There was a dose-dependent inverse relationship between the use of COX inhibitors and the risk of HCC. The adjusted ORs were 0.75 (95% CI: 0.63-0.90), 0.41 (95% CI: 0.31-0.56), 0.38 (95% CI: 0.25-0.57) and 0.49 (95% CI: 0.31-0.79) for the 28-90, 91-180, 181-360 and >360 cDDDs, respectively (P < .01). In conclusion, the use of COX inhibitors was associated with a reduced risk of HCC in CHB. COX inhibitor may have a chemopreventive role in HCC development in patients with chronic liver disease.
本研究旨在使用全国人群为基础的数据，调查 COX 抑制剂的使用与慢性乙型肝炎（CHB）患者肝细胞癌（HCC）发展风险之间的关系。 研究采用韩国 2002 年至 2013 年全国健康保险服务-全国抽样队列（NHIS-NSC）进行嵌套病例对照研究。我们根据累积定义日剂量（cDDD，<28、28-90、91-180、181-360 和>360）将 COX 抑制剂的使用分为 5 组，调整抗病毒药物的使用，比较 HCC 病例和匹配对照之间 COX 抑制剂的使用。共有 4980 例 CHB 患者被分析为 996 例 HCC 病例和 3984 例匹配对照。在 HCC 组和对照组中，COX 抑制剂使用者（≥28 cDDD）的数量分别为 358 例（36%）和 1814 例（45%）。与非使用者相比，COX 抑制剂的使用与 HCC 发展风险显著降低相关（调整后的优势比[OR]0.62，95%置信区间[CI]0.52-0.73，P <.001）。COX 抑制剂的使用与 HCC 风险之间存在剂量依赖性反比关系。调整后的 OR 分别为 0.75（95%CI：0.63-0.90）、0.41（95%CI：0.31-0.56）、0.38（95%CI：0.25-0.57）和 0.49（95%CI：0.31-0.79）对于 28-90、91-180、181-360 和>360 cDDD，分别（P <.01）。总之，COX 抑制剂的使用与 CHB 患者 HCC 风险降低相关。COX 抑制剂可能在慢性肝病患者的 HCC 发展中具有化学预防作用。
