Tien Peng, Bih Zen Lang, Chen Wan-Ming, Shia Ben-Chang, Wu Szu-Yuan, Chiang Ching-Wen
Department of Otorhinolaryngology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital Yilan 265, Taiwan.
Department of Emergency Medicine, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital Yilan 265, Taiwan.
Am J Cancer Res. 2024 Dec 15;14(12):5921-5934. doi: 10.62347/JXMI9007. eCollection 2024.
Betel nut chewing, common in several Asian populations, is linked to increased cancer risk, including oral, esophageal, gastric, and hepatocellular carcinoma. Aspirin shows potential as a chemopreventive agent. This study investigates the association between aspirin use and cancer risk among betel nut chewers. Betel nut chewers aged 18 and older were included, with aspirin use defined as at least 28 cumulative defined daily doses (cDDDs). Propensity score matching and Cox proportional hazards models, adjusted for time-varying covariates, were used to assess cancer risk. The study included 46,302 betel nut chewers, equally divided between aspirin users and non-users. Aspirin use was associated with a 31% reduction in overall cancer risk (adjusted hazard ratio [aHR], 0.69; 95% confidence interval [CI], 0.66 to 0.73; P<0.0001). A dose-response relationship was observed, with higher cDDDs of aspirin corresponding to greater reductions in cancer risk. The highest quartile of aspirin use (Quartile 4) showed a 62% reduction in cancer risk (aHR, 0.38; 95% CI, 0.34 to 0.41; P<0.0001). Daily aspirin intensity was also associated with a significant reduction in cancer risk, with doses greater than 1 DDD showing an aHR of 0.54 (95% CI, 0.47 to 0.61; P<0.0001) compared to 1 DDD or less. Aspirin use significantly reduces cancer risk among betel nut chewers in a dose-dependent manner. These findings suggest aspirin as a potential chemopreventive agent in high-risk populations, warranting further investigation.
嚼槟榔在一些亚洲人群中很常见，它与癌症风险增加有关，包括口腔癌、食管癌、胃癌和肝细胞癌。阿司匹林显示出作为化学预防剂的潜力。本研究调查了嚼槟榔者使用阿司匹林与癌症风险之间的关联。纳入了18岁及以上的嚼槟榔者，阿司匹林的使用定义为至少28个累积限定日剂量（cDDD）。采用倾向评分匹配和Cox比例风险模型，并对随时间变化的协变量进行调整，以评估癌症风险。该研究包括46302名嚼槟榔者，阿司匹林使用者和非使用者各占一半。使用阿司匹林与总体癌症风险降低31%相关（调整后的风险比[aHR]，0.69；95%置信区间[CI]，0.66至0.73；P<0.0001）。观察到剂量反应关系，阿司匹林的cDDD越高，癌症风险降低幅度越大。阿司匹林使用量最高的四分位数（四分位数4）显示癌症风险降低62%（aHR，0.38；95%CI，0.34至0.41；P<0.0001）。每日阿司匹林服用强度也与癌症风险显著降低相关，与1个DDD或更低剂量相比，大于1个DDD的剂量显示aHR为0.54（95%CI，0.47至0.61；P<0.0001）。使用阿司匹林以剂量依赖的方式显著降低嚼槟榔者的癌症风险。这些发现表明阿司匹林在高危人群中是一种潜在的化学预防剂，值得进一步研究。
