Department of Gastric Surgery, Fujian Medical University Union Hospital, No.29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.
BMC Cancer. 2020 Jul 9;20(1):638. doi: 10.1186/s12885-020-07117-4.
Many studies have found that use of aspirin can lengthen survival in patients with gastrointestinal cancer. The aim of this study was to assess the survival benefit of aspirin use compared with non-aspirin use for patients with esophageal, gastric or colorectal cancer.
We searched online databases, including PubMed, the Cochrane Library, Embase and www.clinicaltrials.gov for studies that were conducted, before April 30th, 2020, to identify relevant studies. Overall survival and cancer-specific survival of esophageal, gastric and colorectal cancers among aspirin users were compared with those among non-aspirin users. Data extraction and quality evaluation were independently conducted by 2 investigators. A meta-analysis was performed to calculate the pooled risk ratios (RRs) for overall survival and cancer-specific survival by using either a fixed-effects model or a random-effects model.
A total of 18 studies were included in this meta-analysis, with more than 74,936 patients. There were no significant differences between postdiagnosis aspirin use and overall survival for esophageal and gastric cancers. For colorectal cancer, a benefit that was associated with postdiagnosis aspirin use was observed for overall survival and cancer-specific survival [HR = 0.83, 95%CI(0.75, 0.9.);HR = 0.78, 95%CI(0.66, 0.92), respectively. However, a prediagnosis of aspirin use did not provide a benefit for overall or cancer-specific survival in colorectal cancer. HR values for overall and cancer-specific survival benefits for colorectal cancer associated with both prediagnosis and postdiagnosis aspirin were as follows: HR = 0.75, 95%CI(0.61, 0.92) and HR = 0.78, 95%CI(0.73, 0.85), respectively. In addition, the survival benefit of postdiagnosis aspirin use appeared to be confined to patients with mutated PIK3CA tumors [HR = 0.78, 95%CI(0.50, 0.99)] and was positive for PTGS2 (COX-2) expression [HR = 0.75, 95%CI(0.43, 1.30)].
These findings provide further indications that postdiagnosis aspirin use improves overall survival and cancer-specific survival in colorectal cancer, especially for patients who are positive for PTGS2 (COX-2) expression and PIK3CA-mutated tumors. However, aspirin therapy does not improve overall survival in esophageal and gastric cancers, although the meta-analysis was mainly limited to retrospective studies.
许多研究发现，阿司匹林的使用可以延长胃肠道癌患者的生存时间。本研究旨在评估与非阿司匹林使用者相比，阿司匹林使用者的食管、胃或结直肠癌患者的生存获益。
我们检索了在线数据库，包括 PubMed、Cochrane 图书馆、Embase 和 www.clinicaltrials.gov，以确定截至 2020 年 4 月 30 日之前进行的相关研究。比较阿司匹林使用者与非阿司匹林使用者的食管、胃和结直肠癌的总生存和癌症特异性生存。由两名研究者独立进行数据提取和质量评估。使用固定效应模型或随机效应模型计算总体生存率和癌症特异性生存率的汇总风险比（RR）进行荟萃分析。
本荟萃分析共纳入 18 项研究，超过 74936 例患者。阿司匹林的使用与食管和胃癌的总生存率之间无显著差异。对于结直肠癌，与阿司匹林使用相关的生存获益与总生存率和癌症特异性生存率相关[HR=0.83，95%CI（0.75，0.9.）；HR=0.78，95%CI（0.66，0.92）]。然而，在结直肠癌中，阿司匹林的预诊断使用对总生存率和癌症特异性生存率没有益处。与结直肠癌中阿司匹林的预诊断和诊断后使用相关的总生存率和癌症特异性生存率获益的 HR 值分别为：HR=0.75，95%CI（0.61，0.92）和 HR=0.78，95%CI（0.73，0.85）。此外，阿司匹林使用的生存获益似乎仅限于 PIK3CA 突变肿瘤的患者[HR=0.78，95%CI（0.50，0.99）]，并且对 PTGS2（COX-2）表达呈阳性[HR=0.75，95%CI（0.43，1.30）]。
这些发现进一步表明，阿司匹林的使用可改善结直肠癌患者的总生存率和癌症特异性生存率，特别是对于 PTGS2（COX-2）表达和 PIK3CA 突变肿瘤阳性的患者。然而，阿司匹林治疗并不能改善食管和胃癌患者的总生存率，尽管荟萃分析主要局限于回顾性研究。
