在筛查环境中，低剂量阿司匹林的使用与结直肠息肉和癌症的检出之间的关联。

Association between use of low-dose aspirin and detection of colorectal polyps and cancer in a screening setting.

机构信息

Department of Research, Cancer Registry of Norway, Oslo, Norway; Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.

Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway.

出版信息

Dig Liver Dis. 2023 Aug;55(8):1126-1132. doi: 10.1016/j.dld.2023.01.156. Epub 2023 Feb 6.

DOI:10.1016/j.dld.2023.01.156

PMID:36754644

Abstract

BACKGROUND

The possible protective effect of aspirin on risk of colorectal cancer (CRC) is still highly debated.

METHODS

We used data from Bowel Cancer Screening in Norway, a trial randomizing individuals from general population, aged 50-74 years, to flexible sigmoidoscopy or faecal immunochemical test (FIT), to study the association between aspirin use and detection of CRC and two CRC precursors: adenomas and advanced serrated lesions (ASL). Prescriptions of low-dose aspirin were obtained from Norwegian prescription database. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

Among 64,889 screening participants (24,159 sigmoidoscopy, 40,730 FIT), 314 (0.5%) had CRC, 6,208 (9.6%) adenoma and 659 (1.0%) ASL. Overall and short-term use (<3 years) of low-dose aspirin, versus no use, were not associated with any colorectal lesion. Long-term use (≥3 years) was associated with lower detection of CRC (overall OR 0.66, 95%CI 0.46-0.93; sigmoidoscopy: 0.56, 0.33-0.97; FIT: 0.72, 0.45-1.15), adenomas in sigmoidoscopy arm (overall OR 0.95, 95%CI 0.87-1.03; sigmoidoscopy: 0.89, 0.80-0.99; FIT: 1.03, 0.89-1.18), but not ASLs. We did not observe significant differences in the effect of aspirin according to the location of colorectal lesions.

CONCLUSION

Our results suggest that long-term use of aspirin might have a protective effect against adenomas and colorectal cancer, but not ASLs.

摘要

背景

阿司匹林对结直肠癌（CRC）风险的可能保护作用仍存在很大争议。

方法

我们使用来自挪威结直肠癌筛查的数据，该试验将年龄在 50-74 岁的普通人群随机分为接受乙状结肠镜检查或粪便免疫化学试验（FIT），研究阿司匹林使用与 CRC 和两种 CRC 前体（腺瘤和高级锯齿状病变（ASL））的检测之间的关系。低剂量阿司匹林的处方来自挪威处方数据库。使用逻辑回归估计比值比（OR）和 95%置信区间（CI）。

结果

在 64889 名筛查参与者（24159 名乙状结肠镜检查，40730 名 FIT）中，314 人（0.5%）患有 CRC，6208 人（9.6%）患有腺瘤，659 人（1.0%）患有 ASL。与未使用相比，低剂量阿司匹林的总体和短期（<3 年）使用与任何结直肠病变无关。长期（≥3 年）使用与 CRC 检测率降低相关（总体 OR 0.66，95%CI 0.46-0.93；乙状结肠镜检查：0.56，0.33-0.97；FIT：0.72，0.45-1.15），乙状结肠镜检查组的腺瘤（总体 OR 0.95，95%CI 0.87-1.03；乙状结肠镜检查：0.89，0.80-0.99；FIT：1.03，0.89-1.18），但不是 ASLs。我们没有观察到阿司匹林作用的差异根据结直肠病变的位置。