Shin Sangdeok, Lee Sang Hoon, Lee Minjong, Kim Ji Hyun, Lee Wongu, Lee Hyun Woo, Park Min Soo, Park Seungwoo, Kim Tae Suk, Choi Dae Hee
Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon.
Department of Internal Medicine, Ewha Womans University College of Medicine, Ewha Womans University Seoul Hospital, Gonghang-daero, Gangseo-gu, Seoul, Republic of Korea.
Medicine (Baltimore). 2020 Feb;99(9):e19008. doi: 10.1097/MD.0000000000019008.
Aspirin therapy has shown protective effects against hepatocellular carcinoma (HCC) in preclinical studies. However, it is unclear whether aspirin therapy lowers the risk of HCC in patients with alcoholic cirrhosis.A retrospective analysis of data from 949 consecutive patients with alcoholic cirrhosis who abstained from alcoholic drinking was performed. The primary and secondary outcomes were development of HCC and gastrointestinal bleeding events, respectively. Risk was compared between patients with aspirin treatment and patients who were not treated (non-aspirin group) using a time-varying Cox proportional hazards model for total population and propensity score-matching analysis.The aspirin group included 224 patients and the non-aspirin group had 725 patients. During the study period of median duration of 3.1 years, 133 patients (13.6%) developed HCC. In time-varying Cox proportional analyses, the aspirin group showed a significantly lower risk of HCC (adjusted hazard ratio [aHR]: 0.13; 95% confidence interval [CI]: 0.08-0.21; P < .001). In propensity score-matched pairs, aspirin therapy significantly reduced the risk of HCC (aHR: 0.14; 95% CI: 0.09-0.22; P < .001). In bleeding risk, treatment with aspirin alone was not significantly associated with a higher bleeding risk (aHR: 0.81; 95% CI: 0.45-1.44; P = .46).Aspirin therapy was associated with the lower risk of HCC in patients with alcoholic cirrhosis.
在临床前研究中，阿司匹林治疗已显示出对肝细胞癌（HCC）的保护作用。然而，尚不清楚阿司匹林治疗是否能降低酒精性肝硬化患者患HCC的风险。对949例连续戒酒的酒精性肝硬化患者的数据进行了回顾性分析。主要和次要结局分别为HCC的发生和胃肠道出血事件。使用全人群的时变Cox比例风险模型和倾向评分匹配分析，比较了接受阿司匹林治疗的患者和未接受治疗的患者（非阿司匹林组）之间的风险。阿司匹林组包括224例患者，非阿司匹林组有725例患者。在中位持续时间为3.1年的研究期间，133例患者（13.6%）发生了HCC。在时变Cox比例分析中，阿司匹林组显示HCC风险显著降低（调整后风险比[aHR]：0.13；95%置信区间[CI]：0.08 - 0.21；P <.001）。在倾向评分匹配对中，阿司匹林治疗显著降低了HCC风险（aHR：0.14；95% CI：0.09 - 0.22；P <.001）。在出血风险方面，单独使用阿司匹林治疗与较高的出血风险无显著相关性（aHR：0.81；95% CI：0.45 - 1.44；P = 0.46）。阿司匹林治疗与酒精性肝硬化患者较低的HCC风险相关。
