Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Department of Population Science, American Cancer Society, Atlanta, GA, USA.
J Natl Cancer Inst. 2021 Jul 1;113(7):833-840. doi: 10.1093/jnci/djab008.
Aspirin use reduces colorectal cancer (CRC) incidence, but there is limited evidence regarding associations of aspirin and non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs) with CRC-specific survival.
This prospective analysis includes women and men from the Cancer Prevention Study-II Nutrition Cohort who were cancer free at baseline (1992 or 1993) and diagnosed with CRC during incidence follow-up through 2015. Detailed information on aspirin and non-aspirin NSAID use was self-reported on questionnaires at baseline, in 1997, and every 2 years thereafter. Pre- and postdiagnosis data were available for 2686 and 1931 participants without distant metastases, respectively, among whom 512 and 251 died from CRC during mortality follow-up through 2016. Secondary analyses examined associations between prediagnosis aspirin use and stage at diagnosis (distant metastatic vs localized or regional). All statistical tests were 2-sided.
Long-term regular use of aspirin (>15 times per month) before diagnosis was associated with lower CRC-specific mortality (multivariable-adjusted hazard ratio [HR] = 0.69, 95% confidence interval [CI] = 0.52 to 0.92). Postdiagnosis regular aspirin use was not statistically significantly associated with risk of CRC-specific mortality overall (HR = 0.82, 95% CI = 0.62 to 1.09), although participants who began regular aspirin use only after their diagnosis were at lower risk than participants who did not use aspirin at both the pre- and postdiagnosis periods (HR = 0.60, 95% CI = 0.36 to 0.98). Long-term aspirin use before diagnosis was also associated with lower odds of diagnosis with distant metastases (multivariable-adjusted odds ratio = 0.73, 95% CI = 0.53 to 0.99).
Our results suggest that long-term aspirin use before a diagnosis of nonmetastatic colorectal cancer may be associated with lower CRC-specific mortality after diagnosis, consistent with possible inhibition of micrometastases before diagnosis.
阿司匹林的使用可降低结直肠癌（CRC）的发病率，但关于阿司匹林和非阿司匹林非甾体抗炎药（NSAIDs）与 CRC 特异性生存的相关性，证据有限。
本前瞻性分析纳入了癌症预防研究-II 营养队列中的女性和男性，他们在基线时（1992 年或 1993 年）无癌症，在发病随访期间（1992 年至 2015 年）被诊断为 CRC。在基线、1997 年和此后每 2 年的调查问卷上，详细报告了阿司匹林和非阿司匹林 NSAID 的使用情况。在没有远处转移的 2686 名参与者中，分别有 2686 名和 1931 名参与者获得了诊断前和诊断后的数据，其中 512 名和 251 名参与者在 2016 年的死亡率随访期间死于 CRC。次要分析检查了诊断前阿司匹林使用与诊断时的分期（远处转移性与局限性或区域性）之间的关系。所有统计检验均为双侧。
长期定期使用阿司匹林（>每月 15 次）与较低的 CRC 特异性死亡率相关（多变量调整后的危险比 [HR] = 0.69，95%置信区间 [CI] = 0.52 至 0.92）。总体而言，诊断后定期使用阿司匹林与 CRC 特异性死亡率无统计学显著相关性（HR = 0.82，95%CI = 0.62 至 1.09），尽管仅在诊断后开始定期使用阿司匹林的参与者的风险低于在诊断前和诊断后均未使用阿司匹林的参与者（HR = 0.60，95%CI = 0.36 至 0.98）。诊断前长期使用阿司匹林也与远处转移的诊断几率降低相关（多变量调整后的比值比 = 0.73，95%CI = 0.53 至 0.99）。
我们的研究结果表明，在诊断非转移性结直肠癌之前长期使用阿司匹林可能与诊断后 CRC 特异性死亡率降低有关，这与诊断前可能抑制微转移相一致。
