Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, OH, USA.
Department of Medicine, Maulana Azad Medical College, New Delhi, India.
Dis Esophagus. 2024 Jul 3;37(7). doi: 10.1093/dote/doae022.
Despite advancing treatment methods, esophageal cancer (EC) maintains a high mortality rate and poor prognosis. Through various mechanisms, aspirin has been suggested to have a chemopreventive effect on EC. However, the long-term impact, particularly regarding the rate of metastasis, needs to be further elucidated. NIS 2016-2020 was used to identify adult patients (age > 18 years) with EC using ICD-10 codes. Patients with missing demographics and mortality were excluded. Patients were stratified into two groups based on aspirin use. Data were collected on patient demographics, Elixhauser Comorbidity Index (ECI), and comorbidities (hypertension, chronic pulmonary disease, coronary artery disease (CAD), chronic kidney disease (CKD), congestive heart failure (CHF), coagulopathy, alcohol use, smoking, and obesity). The outcomes studied were rates of total metastasis, gastrointestinal (GI) metastasis, non-GI metastasis, and lymphoid metastasis. Multivariate logistic regression analysis was performed to evaluate the impact of aspirin use on various metastases after adjusting for patient demographics, comorbidities, and ECI. Out of 190,655 patients, 20,650 (10.8%) patients were aspirin users. Majority of the patients in the aspirin group were aged > 65 years (74.7%), males (82.1%), White race (84%), and had medicare insurance (71%). There was a higher incidence of diabetes, hypertension, chronic pulmonary disease, CAD, CKD, CHF, and smoking in aspirin users than non-aspirin users. Patients with aspirin users had a lower incidence of metastasis (28.9% vs. 38.7%, P < 0.001), GI metastasis (14.2% vs. 20.6%, P < 0.001), non-GI metastasis (15.1% vs. 22%, P < 0.001), and lymphoid metastasis (8.9% vs. 11.3%, P < 0.001) than non-aspirin users. After adjusting for confounding factors, patients with aspirin use had lower odds of having metastasis (aOR-0.73, 95% CI-0.70-0.77, P < 0.001). Our study noted that aspirin use is associated with a reduction in the rate of metastasis in patients with EC. These studies support the use of aspirin in patients with EC and suggest the need for further studies to understand the mechanism by which aspirin use reduces metastasis in patients with EC.
尽管治疗方法不断进步，食管癌（EC）的死亡率和预后仍较差。通过多种机制，阿司匹林被认为对 EC 具有化学预防作用。然而，其长期影响，特别是转移率，仍需要进一步阐明。利用 NIS 2016-2020 数据库，我们使用 ICD-10 代码识别出患有 EC 的成年患者（年龄>18 岁）。排除了缺少人口统计学和死亡率数据的患者。根据阿司匹林的使用情况将患者分为两组。收集患者的人口统计学、Elixhauser 合并症指数（ECI）和合并症（高血压、慢性肺部疾病、冠心病、慢性肾脏病、充血性心力衰竭、凝血障碍、酒精使用、吸烟和肥胖）的数据。研究的结果是总转移率、胃肠道（GI）转移率、非 GI 转移率和淋巴转移率。多变量逻辑回归分析用于评估调整患者人口统计学、合并症和 ECI 后，阿司匹林使用对各种转移的影响。在 190655 名患者中，有 20650 名（10.8%）患者为阿司匹林使用者。阿司匹林组中的大多数患者年龄>65 岁（74.7%）、男性（82.1%）、白种人（84%）和拥有医疗保险（71%）。阿司匹林使用者的糖尿病、高血压、慢性肺部疾病、冠心病、慢性肾脏病、充血性心力衰竭和吸烟的发生率高于非阿司匹林使用者。阿司匹林使用者的转移率（28.9% vs. 38.7%，P<0.001）、GI 转移率（14.2% vs. 20.6%，P<0.001）、非 GI 转移率（15.1% vs. 22%，P<0.001）和淋巴转移率（8.9% vs. 11.3%，P<0.001）均低于非阿司匹林使用者。调整混杂因素后，阿司匹林使用者发生转移的可能性较低（OR=0.73，95%CI=0.70-0.77，P<0.001）。我们的研究表明，阿司匹林的使用与 EC 患者转移率的降低有关。这些研究支持在 EC 患者中使用阿司匹林，并表明需要进一步研究以了解阿司匹林使用降低 EC 患者转移率的机制。
