Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
Cancer. 2021 Sep 1;127(17):3145-3155. doi: 10.1002/cncr.33623. Epub 2021 May 11.
Studying the differential impact of aspirin and other nonsteroidal anti-inflammatory drugs across the stages of colorectal neoplasia from early adenoma to cancer is critical for understanding the benefits of these widely used drugs.
With 13 years of follow-up, the authors prospectively evaluated the association between aspirin and ibuprofen use and incident distal adenoma (1221 cases), recurrent adenoma (862 cases), and incident colorectal cancer (CRC; 2826 cases) among men and women in the population-based Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. With multivariable-adjusted models, odds ratio (ORs) and 95% confidence intervals (CIs) for adenoma incidence and recurrence and hazard ratios (HRs) and 95% CIs for incident CRC were determined.
The authors observed a significantly reduced risk of incident adenoma with ibuprofen use (≥30 vs <4 pills per month: OR, 0.76 [95% CI, 0.60-0.95]; P = .04), particularly advanced adenoma (OR, 0.48 [95% CI, 0.28-0.83]; P = .005). Among those with a previous adenoma detected through screening, aspirin use was associated with a decreased risk of advanced recurrent adenoma (≥30 vs <4 pills per month: OR, 0.56 [95% CI, 0.36-0.87]; P = 0.006). Both aspirin (HR, 0.88 [95% CI, 0.81-0.96]; P <.0001) and ibuprofen use (HR, 0.81 [95% CI, 0.70-0.93); P = 0.003) ≥30 versus <4 pills per month were significantly associated with reduced CRC risk.
In this large prospective study with long-term follow-up, a beneficial role for not only aspirin, but also ibuprofen, in preventing advanced adenoma and curbing progression to recurrence and cancer among older adults was observed.
研究阿司匹林和其他非甾体抗炎药在结直肠肿瘤从早期腺瘤到癌症的各个阶段的差异影响对于理解这些广泛使用的药物的益处至关重要。
作者通过 13 年的随访，前瞻性评估了阿司匹林和布洛芬的使用与男性和女性中人群为基础的前列腺癌、肺癌、结直肠癌和卵巢癌筛查试验中发生的远端腺瘤（1221 例）、复发性腺瘤（862 例）和结直肠癌（CRC；2826 例）之间的关联。通过多变量调整模型，确定了腺瘤发病率和复发的优势比（OR）和 95%置信区间（CI），以及 CRC 发病的风险比（HR）和 95%CI。
作者观察到，与布洛芬的使用（≥30 片/月与 <4 片/月：OR，0.76[95%CI，0.60-0.95]；P =.04），尤其是高级别腺瘤（OR，0.48[95%CI，0.28-0.83]；P =.005）的发生风险显著降低。在通过筛查发现先前存在腺瘤的人群中，阿司匹林的使用与高级别复发性腺瘤（≥30 片/月与 <4 片/月：OR，0.56[95%CI，0.36-0.87]；P = 0.006）的发生风险降低相关。阿司匹林（HR，0.88[95%CI，0.81-0.96]；P <.0001）和布洛芬（HR，0.81[95%CI，0.70-0.93]；P = 0.003）的使用均与 CRC 风险降低显著相关，使用剂量为≥30 片/月与<4 片/月。
在这项具有长期随访的大型前瞻性研究中，观察到阿司匹林和布洛芬均在预防老年人的高级别腺瘤和抑制复发和癌症进展方面发挥有益作用。
