Paladiya Ruchir, Khoury Neil, Shah Mihir, Moond Vishali, Patel Nishit, Bahirwani Janak, Garg Ayushi, Sohal Aalam, Vaziri Haleh
Departments of Medicine.
Gastroenterology, University of Connecticut Health Center, Farmington, CT.
J Clin Gastroenterol. 2025 Jul 1;59(6):569-575. doi: 10.1097/MCG.0000000000002045.
Despite advancements in treatment strategies, the mortality from colorectal cancer (CRC) remains high. Evidence suggests that aspirin (ASA) may have a protective effect on CRC incidence and metastasis through various mechanisms. The 2016 to 2020 National Inpatient Sample was used to identify adult patients (age above 18 y) with the principal diagnosis of CRC. Patients were stratified into 2 groups based on ASA use. The outcomes studied were in-hospital mortality and rates of total, gastrointestinal (GI), non-GI, and lymphoid metastasis. A multivariate logistic regression analysis was performed to evaluate the impact of ASA use on outcomes after adjusting for patient demographics, comorbidities, and the Elixhauser Comorbidity Index (ECI). Of the 814,270 patients, 88,620 (10.8%) used ASA, with the majority being aged above 65 years (78%), male (57%), white (77.6%), and had Medicare insurance (74.5%). There was a higher prevalence of Diabetes mellitus, Hypertension, Chronic pulmonary disease, Coronary artery disease, Chronic kidney disease, Chronic heart failure, Obesity, and Smoking among aspirin users than among non-ASA users. Patients who used ASA had a lower prevalence of total (47.3% vs. 32.5%, P <0.001), GI (22.2% vs. 32.4%, P <0.001), non-GI (9.9% vs. 15.3%, P <0.001), and lymphoid (9.3% vs. 10.9%, P <0.001) metastasis compared with those who did not use ASA. After adjusting for confounding factors, patients with ASA use had lower odds of total (aOR: 0.75, 95% CI: 0.72-0.78, P <0.001), GI (aOR: 0.74, 95% CI: 0.71-0.77, P <0.001), non-GI (aOR: 0.72, 95% CI: 0.68-0.77, P <0.1), and statistically insignificant odds of lymphoid (aOR: 0.95, 95% CI: 0.90-1.00, P =0.098) metastasis. The use of ASA is associated with a decrease in the prevalence of metastasis among individuals diagnosed with CRC, but additional studies are required to elucidate the mechanism and duration of therapy needed to be effective.
尽管治疗策略有所进步，但结直肠癌（CRC）的死亡率仍然很高。有证据表明，阿司匹林（ASA）可能通过多种机制对CRC的发生和转移具有保护作用。使用2016年至2020年全国住院患者样本，以识别主要诊断为CRC的成年患者（年龄在18岁以上）。根据ASA的使用情况将患者分为两组。研究的结局指标为住院死亡率以及总转移率、胃肠道（GI）转移率、非胃肠道转移率和淋巴转移率。进行多因素逻辑回归分析，以评估在调整患者人口统计学、合并症和埃利克斯豪泽合并症指数（ECI）后，ASA使用对结局的影响。在814270例患者中，88620例（10.8%）使用了ASA，其中大多数年龄在65岁以上（78%）、男性（57%）、白人（77.6%）且拥有医疗保险（74.5%）。与未使用ASA的患者相比，使用ASA的患者中糖尿病、高血压、慢性肺病、冠状动脉疾病、慢性肾病、慢性心力衰竭、肥胖和吸烟的患病率更高。与未使用ASA的患者相比，使用ASA的患者总转移率（47.3%对32.5%，P<0.001）、胃肠道转移率（22.2%对32.4%，P<0.001）、非胃肠道转移率（9.9%对15.3%，P<0.001）和淋巴转移率（9.3%对10.9%，P<0.001）较低。在调整混杂因素后，使用ASA的患者发生总转移（调整后比值比：0.75，95%置信区间：0.72-0.78，P<0.001）、胃肠道转移（调整后比值比：0.74，95%置信区间：0.71-0.77，P<0.001）、非胃肠道转移（调整后比值比：0.72，95%置信区间：0.68-0.77，P<0.1）的几率较低，而发生淋巴转移的几率无统计学意义（调整后比值比：0.95，95%置信区间：0.90-1.00，P=0.098）。使用ASA与诊断为CRC的个体转移率降低相关，但需要进一步研究以阐明其机制以及有效治疗所需的持续时间。
