Lee Teng-Yu, Hsu Yao-Chun, Ho Hsiu J, Lin Jaw-Town, Chen Yi-Ju, Wu Chun-Ying
Division of Gastroenterology & Hepatology, Taichung Veterans General Hospital, Taichung, Taiwan.
School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
EClinicalMedicine. 2023 Jun 29;61:102065. doi: 10.1016/j.eclinm.2023.102065. eCollection 2023 Jul.
Emerging laboratory and animal studies suggest that aspirin may prevent non-alcoholic fatty liver disease (NAFLD)-related hepatocellular carcinoma (HCC), however clinical evidence remains lacking.
Using Taiwan's National Health Insurance Research Database, we screened 145,212 NAFLD patients from 1997 through 2011. After excluding any confounding conditions, 33,484 patients who continuously received a daily dose of aspirin for 90 days or more (treated group), along with 55,543 patients who had not received antiplatelet therapy (untreated group), were respectively recruited. Inverse probability of treatment weighting using the propensity score was applied to balance the baseline characteristics. Cumulative incidence of, and hazard ratio (HR) for HCC occurrence were analyzed after adjusting competing events. The high-risk patients, who were defined as age ≥ 55 years & elevated serum alanine aminotransferase, were further analyzed.
The 10-year cumulative incidence of HCC in the treated group was significantly lower than that in the untreated group (0.25% [95% CI, 0.19-0.32%] 0.67% [95% CI, 0.54-0.81%]; P < 0.001). Aspirin therapy was significantly associated with a reduced HCC risk (adjusted HR [aHR] 0.48 [95% CI, 0.37-0.63]; P < 0.001). In the high-risk patients, the 10-year cumulative incidence of HCC in the treated group was significantly lower than that in the untreated group (3.59% [95% CI, 2.99-4.19%] 6.54% [95% CI, 5.65-7.42%]; P < 0.001). Aspirin therapy remained associated with a reduced HCC risk (aHR 0.63 [95% CI, 0.53-0.76]; P < 0.001). Subgroup sensitivity analyses verified this significant association in nearly all subgroups. In the time-varying model amongst aspirin users, HCC risk was significantly lower through the use of aspirin for ≥ 3 years (aHR 0.64 [95% CI, 0.44-0.91]; P = 0.013), when compared with short-term use (< 1 year).
Daily aspirin therapy is significantly associated with a reduced HCC risk in NAFLD patients.
Ministry of Science and Technology, Ministry of Health and Welfare, and Taichung Veterans General Hospital, Taiwan.
新出现的实验室和动物研究表明，阿司匹林可能预防非酒精性脂肪性肝病（NAFLD）相关的肝细胞癌（HCC），然而临床证据仍然缺乏。
利用台湾地区国民健康保险研究数据库，我们筛选了1997年至2011年期间的145,212例NAFLD患者。在排除任何混杂因素后，分别招募了33,484例连续服用每日剂量阿司匹林90天或更长时间的患者（治疗组）以及55,543例未接受抗血小板治疗的患者（未治疗组）。采用倾向评分的逆概率加权法来平衡基线特征。在调整竞争事件后，分析了HCC发生的累积发病率和风险比（HR）。对定义为年龄≥55岁且血清丙氨酸氨基转移酶升高的高危患者进行了进一步分析。
治疗组HCC的10年累积发病率显著低于未治疗组（0.25%[95%CI，0.19 - 0.32%]对0.67%[95%CI，0.54 - 0.81%]；P<0.001）。阿司匹林治疗与降低的HCC风险显著相关（调整后HR[aHR]0.48[95%CI，0.37 - 0.63]；P<0.001）。在高危患者中，治疗组HCC的10年累积发病率显著低于未治疗组（3.59%[95%CI，2.99 - 4.19%]对6.54%[95%CI，5.65 - 7.42%]；P<0.001）。阿司匹林治疗仍与降低的HCC风险相关（aHR 0.63[95%CI，0.53 - 0.76]；P<0.001）。亚组敏感性分析在几乎所有亚组中均证实了这种显著关联。在阿司匹林使用者的时变模型中，与短期使用（<1年）相比，使用阿司匹林≥3年时HCC风险显著降低（aHR 0.64[95%CI，0.44 - 0.91]；P = 0.013）。
每日服用阿司匹林治疗与NAFLD患者降低的HCC风险显著相关。
台湾地区科学技术部、卫生福利部以及台中荣民总医院。
