Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany.
BMC Surg. 2021 Feb 22;21(1):98. doi: 10.1186/s12893-021-01083-9.
The importance of platelets in the pathogenesis of metastasis formation is increasingly recognized. Although evidence from epidemiologic studies suggests positive effects of aspirin on metastasis formation, there is little clinical data on the perioperative use of this drug in pancreatic cancer patients.
From all patients who received curative intent surgery for pancreatic cancer between 2014 and 2016 at our institution, we identified 18 patients that took aspirin at time of admission and continued to throughout the inpatient period. Using propensity score matching, we selected a control group of 64 patients without aspirin intake from our database and assessed the effect of aspirin medication on overall, disease-free, and hematogenous metastasis-free survival intervals as endpoints.
Aspirin intake proved to be independently associated with improved mean overall survival (OS) (46.5 vs. 24.6 months, *p = 0.006), median disease-free survival (DFS) (26 vs. 10.5 months, *p = 0.001) and mean hematogenous metastasis-free survival (HMFS) (41.9 vs. 16.3 months, *p = 0.005). Three-year survival rates were 61.1% in patients with aspirin intake vs. 26.3% in patients without aspirin intake. Multivariate cox regression showed significant independent association of aspirin with all three survival endpoints with hazard ratios of 0.36 (95% CI 0.15-0.86) for OS (*p = 0.021), 0.32 (95% CI 0.16-0.63) for DFS (**p = 0.001), and 0.36 (95% CI 0.16-0.77) for HMFS (*p = 0.009).
Patients in our retrospective, propensity-score matched study showed significantly better overall survival when taking aspirin while undergoing curative surgery for pancreatic cancer. This was mainly due to a prolonged metastasis-free interval following surgery.
血小板在转移形成的发病机制中的重要性日益得到认可。尽管来自流行病学研究的证据表明阿司匹林对转移形成有积极影响，但关于在胰腺癌患者围手术期使用这种药物的临床数据很少。
我们从 2014 年至 2016 年在我们的机构接受根治性手术治疗的所有胰腺癌患者中，确定了 18 名在入院时服用阿司匹林并在住院期间继续服用的患者。通过倾向评分匹配，我们从数据库中选择了 64 名没有服用阿司匹林的对照组患者，并评估了阿司匹林药物对总体、无病和血行无转移生存率的影响。
阿司匹林的摄入被证明与改善的平均总生存期（OS）（46.5 与 24.6 个月，*p=0.006）、中位无病生存期（DFS）（26 与 10.5 个月，*p=0.001）和平均血行无转移生存期（HMFS）（41.9 与 16.3 个月，*p=0.005）独立相关。有阿司匹林摄入的患者 3 年生存率为 61.1%，而无阿司匹林摄入的患者为 26.3%。多变量 Cox 回归显示，阿司匹林与所有三个生存终点均有显著的独立关联，OS 的风险比为 0.36（95%CI 0.15-0.86）（*p=0.021），DFS 的风险比为 0.32（95%CI 0.16-0.63）（**p=0.001），HMFS 的风险比为 0.36（95%CI 0.16-0.77）（*p=0.009）。
在我们的回顾性、倾向评分匹配研究中，接受根治性手术治疗胰腺癌的患者在服用阿司匹林时，总生存率显著提高。这主要是由于手术后无转移间隔延长所致。
