Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Cancer Prev Res (Phila). 2022 Apr 1;15(4):265-272. doi: 10.1158/1940-6207.CAPR-21-0413.
Prospective data examining the association of aspirin use, according to dose and duration, with long-term risk of gastric adenocarcinoma in non-Asian cohorts are lacking. We evaluated the association between aspirin use and risk of gastric adenocarcinoma in two large prospective U.S. cohort studies, the Nurses' Health Study and the Health Professionals Follow-up Study. Cox proportional hazards regression models were used to calculate multivariable adjusted HRs and 95% confidence intervals (CI). Among the 159,116 participants, we documented 316 gastric adenocarcinoma cases (176 women, 140 men) over 34 years encompassing 4.5 million person-years. Among women, regular aspirin use (at least two times or more per week) was significantly associated with lower risk of gastric adenocarcinoma (multivariable HR, 0.52; 95% CI, 0.37-0.73) compared with nonregular use. However, regular aspirin use was not associated with gastric adenocarcinoma risk among men (multivariable HR, 1.08; 95% CI, 0.77-1.52; Pheterogeneity for sex = 0.003). Among women, the lower risk of gastric adenocarcinoma was more apparent with increasing duration of aspirin use (Ptrend < 0.001) and more than five tablets per week (multivariable HR, 0.51; 95% CI, 0.31-0.84). Regular, long-term aspirin use was associated with lower risk of gastric adenocarcinoma among women, but not men. The benefit appeared after at least 10 years of use and was maximized at higher doses among women. The heterogeneity by sex in the association of aspirin use with risk of gastric adenocarcinoma requires further investigation.
Novel prevention is urgently needed to reduce incidence and mortality of gastric cancer. We found that regular aspirin use was associated with lower risk of gastric adenocarcinoma among women, but not men. The benefit appeared after at least 10 years of use and was maximized at higher doses among women. See related Spotlight, p. 213.
缺乏前瞻性数据来检验阿司匹林的使用剂量和持续时间与非亚洲人群中胃腺癌长期风险之间的关联。我们在两项大型美国前瞻性队列研究中评估了阿司匹林的使用与胃腺癌风险之间的关联，这两项研究分别为护士健康研究和卫生专业人员随访研究。使用 Cox 比例风险回归模型计算多变量调整后的 HR 和 95%置信区间（CI）。在 159116 名参与者中，我们在 34 年期间共记录了 316 例胃腺癌病例（女性 176 例，男性 140 例），共涉及 450 万人年。在女性中，与非规律使用阿司匹林相比，规律使用阿司匹林（至少每周两次或更多次）与胃腺癌风险显著降低相关（多变量 HR，0.52；95%CI，0.37-0.73）。然而，在男性中，规律使用阿司匹林与胃腺癌风险无关（多变量 HR，1.08；95%CI，0.77-1.52；性别异质性 P=0.003）。在女性中，随着阿司匹林使用时间的延长（P 趋势 <0.001）和每周使用超过 5 片，胃腺癌风险降低更为明显（多变量 HR，0.51；95%CI，0.31-0.84）。规律、长期使用阿司匹林与女性而非男性的胃腺癌风险降低相关。这种益处似乎在使用至少 10 年后出现，并在女性中剂量更高时达到最大值。阿司匹林使用与胃腺癌风险之间的关联在性别上存在异质性，需要进一步研究。
迫切需要新的预防措施来降低胃癌的发病率和死亡率。我们发现，规律使用阿司匹林与女性而非男性的胃腺癌风险降低相关。这种益处似乎在使用至少 10 年后出现，并在女性中剂量更高时达到最大值。参见相关焦点文章，第 213 页。
