阿司匹林是否降低结直肠癌的发病率、复发率和死亡率？一项随机临床试验的荟萃分析。

Does aspirin reduce the incidence, recurrence, and mortality of colorectal cancer? A meta-analysis of randomized clinical trials.

机构信息

Department of Epidemiology and Health Statistics, School of Public Health Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, People's Republic of China.

AMITA Health Saint Joseph Hospital Chicago, 2900 N. Lake Shore Drive, Chicago, IL, 60657, USA.

出版信息

Int J Colorectal Dis. 2021 Aug;36(8):1653-1666. doi: 10.1007/s00384-021-03889-8. Epub 2021 Feb 16.

DOI:10.1007/s00384-021-03889-8

PMID:33594505

Abstract

BACKGROUND

Colorectal cancer (CRC) is the third most common diagnosed cancer and the third leading cause of all cancer deaths in the USA. Some evidences are shown that aspirin can reduce the morbidity and mortality of different cancers, including CRC. Aspirin has become a new focus of cancer prevention and treatment research so far; clinical studies, however, found conflicting conclusions of its anti-cancer characteristics. This study is to summarize the latest evidence of correlation between aspirin use and CRC and/or colorectal adenomas.

METHODS

Databases were searched to identify randomized controlled trials (RCTs) in the salvage setting. The pooled relative risk (RR) with 95% confidence interval (CI) was used to estimate the effect of aspirin on colorectal cancer and/or colorectal adenomas. Subgroup analysis and sensitivity analysis were also conducted.

RESULTS

The result showed that aspirin use was not associated with incidence of CRC (RR 0.97; 95% CI 0.84-1.12; P = 0.66; I = 34%), aspirin use was found to be associated with reduced recurrence of colorectal adenomas (RR 0.83; 95% CI 0.72-0.95; P = 0.006; I = 63%) and reduced mortality of CRC (RR 0.79; 95% CI 0.64-0.97; P = 0.02; I = 14%). Subgroup analysis found a statistically significant association in low dose with a pooled RR of 0.85 (95% CI 0.74-0.99; P = 0.03; I = 31%).

CONCLUSIONS

This meta-analysis of randomized controlled trial data indicates that aspirin reduces the overall risk of recurrence and mortality of CRC and/or colorectal adenomas. Incidence of CRC was also reduced with low-dose aspirin. The emerging evidence on aspirin's cancer protection role highlights an exciting time for cancer prevention through low-cost interventions.

TRIAL REGISTRATION

Clinicaltrials.gov no: CRD42020208852; August 18, 2020; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020208852 ).

摘要

背景

结直肠癌（CRC）是美国第三大常见癌症诊断和癌症死亡的第三大主要原因。有证据表明，阿司匹林可以降低不同癌症（包括 CRC）的发病率和死亡率。到目前为止，阿司匹林已成为癌症预防和治疗研究的新焦点；然而，临床研究得出了相互矛盾的结论。本研究旨在总结阿司匹林使用与 CRC 和/或结直肠腺瘤之间相关性的最新证据。

方法

检索数据库以确定补救环境中的随机对照试验（RCT）。使用合并的相对风险（RR）和 95%置信区间（CI）来估计阿司匹林对结直肠癌和/或结直肠腺瘤的影响。还进行了亚组分析和敏感性分析。

结果

结果表明，阿司匹林的使用与 CRC 的发生率无关（RR 0.97；95%CI 0.84-1.12；P = 0.66；I = 34%），但与结直肠腺瘤的复发减少相关（RR 0.83；95%CI 0.72-0.95；P = 0.006；I = 63%）和结直肠癌死亡率降低相关（RR 0.79；95%CI 0.64-0.97；P = 0.02；I = 14%）。亚组分析发现，低剂量阿司匹林具有统计学意义，合并 RR 为 0.85（95%CI 0.74-0.99；P = 0.03；I = 31%）。