Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston.
Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston.
JAMA Oncol. 2021 Mar 1;7(3):428-435. doi: 10.1001/jamaoncol.2020.7338.
Although aspirin is recommended for the prevention of colorectal cancer (CRC) among adults aged 50 to 59 years, recent data from a randomized clinical trial suggest a lack of benefit and even possible harm among older adults.
To examine the association between aspirin use and the risk of incident CRC among older adults.
DESIGN, SETTING, AND PARTICIPANTS: A pooled analysis was conducted of 2 large US cohort studies, the Nurses' Health Study (June 1, 1980-June 30, 2014) and Health Professionals Follow-up Study (January 1, 1986-January 31, 2014). A total of 94 540 participants aged 70 years or older were included and followed up to June 30, 2014, for women or January 31, 2014, for men. Participants with a diagnosis of any cancer, except nonmelanoma skin cancer, or inflammatory bowel disease were excluded. Statistical analyses were conducted from December 2019 to October 2020.
Cox proportional hazards models were used to calculate multivariable adjusted hazard ratios (HRs) and 95% CIs for incident CRC.
Among the 94 540 participants (mean [SD] age, 76.4 [4.9] years for women, 77.7 [5.6] years for men; 67 223 women [71.1%]; 65 259 White women [97.1%], 24 915 White men [96.0%]) aged 70 years or older, 1431 incident cases of CRC were documented over 996 463 person-years of follow-up. After adjustment for other risk factors, regular use of aspirin was associated with a significantly lower risk of CRC at or after age 70 years compared with nonregular use (HR, 0.80; 95% CI, 0.72-0.90). However, the inverse association was evident only among aspirin users who initiated aspirin use before age 70 years (HR, 0.80; 95% CI, 0.67-0.95). In contrast, initiating aspirin use at or after 70 years was not significantly associated with a lower risk of CRC (HR, 0.92; 95% CI, 0.76-1.11).
Initiating aspirin at an older age was not associated with a lower risk of CRC in this pooled analysis of 2 cohort studies. In contrast, those who used aspirin before age 70 years and continued into their 70s or later had a reduced risk of CRC.
虽然阿司匹林被推荐用于预防 50 至 59 岁成年人的结直肠癌（CRC），但最近一项随机临床试验的数据表明，阿司匹林对老年人可能没有益处，甚至可能有害。
研究阿司匹林使用与老年人 CRC 发病风险之间的关系。
设计、地点和参与者：对两项大型美国队列研究进行了汇总分析，护士健康研究（1980 年 6 月 1 日至 6 月 30 日）和卫生专业人员随访研究（1986 年 1 月 1 日至 1986 年 1 月 31 日）。共纳入 94540 名年龄在 70 岁或以上的参与者，随访至 2014 年 6 月 30 日（女性）或 2014 年 1 月 31 日（男性）。排除有任何癌症（除非黑色素瘤皮肤癌和炎症性肠病）诊断的参与者。统计分析于 2019 年 12 月至 2020 年 10 月进行。
使用 Cox 比例风险模型计算多变量调整后的风险比（HR）和 95%置信区间（CI），以评估 CRC 发病风险。
在这两项队列研究中，共纳入了 94540 名年龄在 70 岁或以上的参与者（女性平均[SD]年龄为 76.4[4.9]岁，男性为 77.7[5.6]岁；女性 67223 人[71.1%]；白人女性 65259 人[97.1%]，白人男性 24915 人[96.0%]），在 996463 人年的随访期间共记录了 1431 例 CRC 事件。在调整了其他风险因素后，与不规律使用阿司匹林相比，规律使用阿司匹林与 70 岁及以上 CRC 发病风险显著降低相关（HR，0.80；95%CI，0.72-0.90）。然而，这种负相关仅见于 70 岁前开始使用阿司匹林的阿司匹林使用者中（HR，0.80；95%CI，0.67-0.95）。相比之下，70 岁及以上开始使用阿司匹林与 CRC 发病风险降低无关（HR，0.92；95%CI，0.76-1.11）。
在这两项队列研究的汇总分析中，年龄较大时开始使用阿司匹林与 CRC 发病风险降低无关。相比之下，70 岁之前开始使用阿司匹林并持续使用至 70 岁及以上的患者 CRC 发病风险降低。
