低剂量阿司匹林的使用与 32195 例结直肠癌患者的生存情况：一项全国性队列研究。
Low-dose aspirin use and colorectal cancer survival in 32,195 patients-A national cohort study.
机构信息
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.
出版信息
Cancer Med. 2023 Jan;12(1):315-324. doi: 10.1002/cam4.4859. Epub 2022 Jun 19.
BACKGROUND
Results from previous studies indicate that use of aspirin may improve colorectal cancer (CRC) survival. The aim of this study was to assess whether use of aspirin influences overall survival or CRC-specific survival in an unselected cohort of patients diagnosed with CRC.
METHODS
The study was performed using the Colorectal Cancer Data Base Sweden (CRCBaSe), a mega-linkage originating from the Swedish Colorectal Cancer Register, with additional linkages to other national health care registers. All patients diagnosed with primary CRC stage I-III treated with curative surgery, aged 18-85 years at diagnosis, from 2007 through 2016 were identified. Information on low-dose aspirin use was extracted from the Swedish Prescribed Drug Register. Exposure was defined as dispensed prescription for at least 6 months. Aspirin exposure was analyzed at the time of surgery (yes/no) and as a time-varying exposure during follow-up. Follow-up was restricted to a maximum 6 years, to model 5-year survival. Cox regression models were fitted to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). Adjustments were performed for sex, age, year of diagnosis, Charlson comorbidity index, hypertension, and ASA score as potential confounders.
RESULTS
A total of 32,195 patients diagnosed with CRC were included. 6764 (21%) were exposed to aspirin at the time of CRC surgery. The median time of follow-up was 4.2 years. Aspirin use at the time of surgery was not associated with all-cause (adjusted HR = 1.03, 95% CI: 0.97-1.08) nor CRC-specific mortality (adjusted HR = 0.99, 95% CI: 0.91-1.07). Aspirin use during follow-up was associated with increased all-cause (adjusted HR = 1.09, 95% CI: 1.04-1.15) but not CRC-specific mortality (adjusted HR = 0.98, 95% CI: 0.91-1.06). A CRC-specific effect associated with aspirin was noted from approximately 3 years following surgery.
CONCLUSIONS
In this large nation-wide cohort study there was no convincing association between aspirin use after CRC and OS or CRC-specific survival.
背景
先前的研究结果表明，阿司匹林的使用可能会改善结直肠癌（CRC）的生存情况。本研究旨在评估在未经选择的 CRC 患者队列中，阿司匹林的使用是否会影响总体生存率或 CRC 特异性生存率。
方法
本研究使用了瑞典结直肠癌数据库（CRCBaSe），这是一个源自瑞典结直肠癌登记处的大型链接，还与其他国家卫生保健登记处进行了额外的链接。所有在 2007 年至 2016 年期间被诊断为 I-III 期原发性 CRC 并接受根治性手术治疗、诊断时年龄在 18-85 岁的患者均被纳入研究。从瑞典处方药物登记处提取了低剂量阿司匹林使用信息。暴露定义为至少开具 6 个月的处方。阿司匹林的暴露情况在手术时（是/否）以及在随访期间作为时间变化的暴露进行分析。随访时间限制在 6 年以内，以模拟 5 年生存率。使用 Cox 回归模型估计危险比（HRs）及其 95%置信区间（CIs）。性别、年龄、诊断年份、Charlson 合并症指数、高血压和 ASA 评分被调整为潜在混杂因素。
结果
共纳入了 32195 例被诊断为 CRC 的患者。6764 例（21%）在 CRC 手术时接受了阿司匹林治疗。中位随访时间为 4.2 年。手术时使用阿司匹林与全因死亡率（调整后的 HR=1.03，95%CI：0.97-1.08）或 CRC 特异性死亡率（调整后的 HR=0.99，95%CI：0.91-1.07）均无关。在随访期间使用阿司匹林与全因死亡率（调整后的 HR=1.09，95%CI：1.04-1.15）增加有关，但与 CRC 特异性死亡率无关（调整后的 HR=0.98，95%CI：0.91-1.06）。从手术后大约 3 年开始，注意到了与阿司匹林相关的 CRC 特异性作用。
结论
在这项大规模的全国性队列研究中，CRC 后使用阿司匹林与 OS 或 CRC 特异性生存率之间没有明显的关联。
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