School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia.
Cancer Prev Res (Phila). 2022 Jun 2;15(6):365-375. doi: 10.1158/1940-6207.CAPR-21-0244.
The effects of aspirin on melanoma are unclear, with studies reporting conflicting results. Data from two periods of the ASPirin in Reducing Events in the Elderly (ASPREE) study; the randomized placebo-controlled trial period examining daily 100 mg aspirin in older adults with a median follow-up of 4.7 years, and the second period, an additional 2 years of observational follow-up, were utilized in this secondary analysis to examine whether aspirin exposure is associated with a reduced cutaneous melanoma incidence. All melanoma cases were adjudicated and Cox proportional hazards models were used to compare incidence between randomized treatment groups. ASPREE recruited 19,114 participants with a median age of 74 years. During the trial period, 170 individuals (76 aspirin, 94 placebo) developed an invasive melanoma, and no significant effect of aspirin was observed on incident melanoma [HR = 0.81; 95% confidence interval (CI), 0.60-1.10]. Including the additional 2 years of observational follow-up (median follow-up of 6.3 years), 268 individuals (119 aspirin, 149 placebo) developed an invasive melanoma, and similar results were observed (HR = 0.81; 95% CI, 0.63-1.03). A reduced number of events was observed with aspirin among females in a subgroup analysis (HR = 0.65; 95% CI, 0.44-0.92); however, the interaction effect with males (HR = 0.92; 95% CI, 0.68-1.25) was nonsignificant (P = 0.17). Our findings from this randomized trial do not provide strong support that aspirin is associated with a reduced risk of invasive melanoma in older individuals. Additional studies are required to further explore this relationship.
Melanoma prevention is an important strategy to improve outcomes and while preventive efforts have largely focused on sun protection, the role of potential chemopreventive agents such as aspirin warrants investigation.
阿司匹林对黑色素瘤的影响尚不清楚，研究结果相互矛盾。本研究利用 ASPREE 研究的两个时期的数据，即随机安慰剂对照试验期（观察中位随访 4.7 年的老年患者每日服用 100mg 阿司匹林）和第二个时期（额外 2 年的观察随访），来检查阿司匹林暴露是否与减少皮肤黑色素瘤发病率有关。所有黑色素瘤病例均经裁决，采用 Cox 比例风险模型比较随机治疗组的发病率。ASPREE 纳入了 19114 名中位年龄为 74 岁的参与者。在试验期间，170 名患者（76 名服用阿司匹林，94 名服用安慰剂）发生侵袭性黑色素瘤，未观察到阿司匹林对黑色素瘤发病的显著影响[风险比（HR）=0.81；95%置信区间（CI），0.60-1.10]。包括额外 2 年的观察随访（中位随访 6.3 年），268 名患者（119 名服用阿司匹林，149 名服用安慰剂）发生侵袭性黑色素瘤，结果相似（HR=0.81；95%CI，0.63-1.03）。亚组分析显示，女性服用阿司匹林的事件数量减少（HR=0.65；95%CI，0.44-0.92）；然而，男性的交互效应（HR=0.92；95%CI，0.68-1.25）无统计学意义（P=0.17）。本随机试验的结果并未提供有力证据表明阿司匹林与老年个体侵袭性黑色素瘤风险降低有关。需要进一步研究来进一步探讨这种关系。
黑色素瘤预防是改善结局的重要策略，虽然预防措施主要集中在防晒上，但阿司匹林等潜在化学预防剂的作用值得进一步研究。
