Lee Chern-Horng, Hsu Chiu-Yi, Yen Tzung-Hai, Wu Tsung-Han, Yu Ming-Chin, Hsieh Sen-Yung
Division of General Medicine and Geriatrics, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan.
Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan.
Cancers (Basel). 2023 May 27;15(11):2946. doi: 10.3390/cancers15112946.
Cirrhosis is the primary risk factor for hepatocellular carcinoma (HCC) and gastrointestinal bleeding (GI). We aimed to assess the efficacy and safety of daily aspirin on HCC occurrence, overall survival, and GI bleeding in cirrhotic patients.
A total of 35,898 eligible cases were enrolled for analyses from an initial 40,603 cirrhotic patients without tumor history. Patients continuously treated with aspirin for at least 84 days were in the therapy group, whereas those without treatment were controls. A 1:2 propensity score matching by age, sex, comorbidities, drugs, and significant clinical laboratory tests with covariate assessment was used.
Multivariable regression analyses revealed that daily aspirin use was independently associated with a reduced risk of HCC (three-year HR 0.57; 95% CI 0.37-0.87; = 0.0091; five-year HR 0.63, 95% CI 0.45-0.88; = 0.0072) inversely correlated with the treatment duration [3-12 months: HR 0.88 (95% CI 0.58-1.34); 12-36 months: HR 0.56 (0.31-0.99); and ≥ 36 months: HR 0.37 (0.18-0.76)]. Overall mortality rates were significantly lower among aspirin users compared with untreated controls [three-year HR 0.43 (0.33-0.57); five-year HR 0.51 (0.42-0.63)]. Consistent results were obtained when the laboratory data were included in the propensity score for matching.
Long-term aspirin use significantly reduced the incidence of HCC and overall mortality without increasing gastrointestinal bleeding in cirrhotic patients.
肝硬化是肝细胞癌（HCC）和胃肠道出血（GI）的主要危险因素。我们旨在评估每日服用阿司匹林对肝硬化患者发生HCC、总生存期和胃肠道出血的疗效及安全性。
从最初40603例无肿瘤病史的肝硬化患者中，共纳入35898例符合条件的病例进行分析。持续服用阿司匹林至少84天的患者为治疗组，未接受治疗的患者为对照组。采用年龄、性别、合并症、药物及重要临床实验室检查进行1:2倾向评分匹配，并进行协变量评估。
多变量回归分析显示，每日服用阿司匹林与HCC风险降低独立相关（三年风险比0.57；95%置信区间0.37 - 0.87；P = 0.0091；五年风险比0.63，95%置信区间0.45 - 0.88；P = 0.0072），且与治疗持续时间呈负相关[3 - 12个月：风险比0.88（95%置信区间0.58 - 1.34）；12 - 36个月：风险比0.56（0.31 - 0.99）；≥36个月：风险比0.37（0.18 - 0.76）]。与未治疗的对照组相比，阿司匹林使用者的总死亡率显著更低[三年风险比0.43（0.33 - 0.57）；五年风险比0.51（0.42 - 0.63）]。当将实验室数据纳入倾向评分进行匹配时，得到了一致的结果。
长期服用阿司匹林可显著降低肝硬化患者HCC的发生率和总死亡率，且不增加胃肠道出血。
