Li Pei-Chen, Sung Fung-Chang, Yang Yu-Cih, Chen Weishan, Wang Jen-Hung, Lin Shinn-Zong, Ding Dah-Ching
Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University.
Management Office for Health Data, China Medical University Hospital.
Medicine (Baltimore). 2020 Jul 31;99(31):e21446. doi: 10.1097/MD.0000000000021446.
Aspirin (ASA) exerts an anti-tumor effect via the COX pathway. Clinical studies on the chemopreventive effects of ASA on uterine cancer (UC) remain inconsistent. We used population-based retrospective cohort study to evaluate the UC in ASA users in Taiwanese women. From insurance claims data, we identified 23,342 women received ASA treatment between 2000 and 2010 and a comparison group of same sample size randomly selected from the same database matched by the propensity score. The incidence of UC in the ASA cohort was 10% of that in the comparison group (0.28 vs 2.73 per 10,000 person-years). The Poisson regression analysis estimated adjusted incidence rate ratio (IRR) was 0.10 (95% confidence interval (CI) = 0.09-0.11) for ASA users relatives to comparisons after controlling for covariates. The UC incidence in ASA users decreased with age, from 0.61 per 10,000 person-years in the 20 to 39 years old (adjusted IRR = 0.21, 95% CI = 0.15-0.29) to 0.21 per 10,000 person-years in the 65 to 80 years old (adjusted IRR = 0.15, 95% CI = 0.12-0.16). The incidence was higher in longer term users. Hormone therapy of estradiol was associated with the increase of UC risk in both cohorts, but less in ASA users than comparisons (1.34 vs 4.75 per 10,000 person-years). This study suggests that ASA use was associated with a decreased risk of UC. Further prospective randomized clinical trials are warranted to confirm the association.
阿司匹林（ASA）通过COX途径发挥抗肿瘤作用。关于ASA对子宫癌（UC）化学预防作用的临床研究结果仍不一致。我们采用基于人群的回顾性队列研究来评估台湾女性中使用ASA者的子宫癌情况。从保险理赔数据中，我们识别出2000年至2010年间接受ASA治疗的23342名女性，并从同一数据库中按倾向得分匹配随机选取了相同样本量的对照组。ASA队列中UC的发病率是对照组的10%（每10000人年0.28例 vs 2.73例）。在控制协变量后，泊松回归分析估计ASA使用者相对于对照组的调整发病率比（IRR）为0.10（95%置信区间（CI）=0.09 - 0.11）。ASA使用者中UC的发病率随年龄降低，从20至39岁时的每10000人年中0.61例（调整IRR = 0.21，95% CI = 0.15 - 0.29）降至65至80岁时的每10000人年中0.21例（调整IRR = 0.15，95% CI = 0.12 - 0.16）。长期使用者的发病率更高。两个队列中雌二醇激素治疗均与UC风险增加相关，但ASA使用者中的风险增加程度低于对照组（每10000人年中1.34例 vs 4.75例）。本研究表明，使用ASA与UC风险降低相关。有必要进行进一步的前瞻性随机临床试验来证实这种关联。
