Agustsson Arnar S, Haraldsdottir Sigurdis, Birgisson Helgi, Lund Sigrun H, Ingason Arnar B, Hreinsson Johann P, Björnsson Einar S
Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
Department of Medical Oncology, Landspitali University Hospital of Iceland, Reykjavik, Iceland.
Scand J Gastroenterol. 2025 Jun;60(6):516-525. doi: 10.1080/00365521.2025.2499126. Epub 2025 May 4.
Previous studies have produced conflicting results regarding whether aspirin affects survival in colorectal cancer (CRC) patients. This study examines the relationship between regular aspirin use and survival in CRC patients within a nationwide cohort.
All patients diagnosed with CRC in Iceland from 2000 to 2019 were identified through the Icelandic Cancer Registry. Clinical variables, including medications, were extracted from medical records. Overall survival (OS) and cancer-specific survival (CSS) were calculated. The follow-up period ended on 1 October 2022. The Charlson comorbidity index was used to assess comorbidity burden, and propensity score matching was employed to balance patient characteristics.
Of the 2,561 eligible patients, 22% ( = 559) had been taking aspirin before their CRC diagnosis. Aspirin users were generally older and more frequently male (63% vs. 51%), with a higher comorbidity burden (15% vs. 4.7%). The median follow-up period was 51 months (IQR 14-110). Aspirin users were less likely to receive a stage IV diagnosis. After matching, overall survival (OS) was comparable between aspirin and non-users (HR: 0.94, 95% CI (0.83-1.06), = 0.30). However, cancer-specific survival (CSS) was significantly better for aspirin users (HR: 0.79, 95% CI (0.65-0.95), = 0.01). This benefit was not observed in patients with stages I-III CRC or those diagnosed due to gastrointestinal bleeding.
Aspirin use was linked to improved CSS but not OS. The findings suggest aspirin's potential role in slowing or hindering progression to stage IV cancer.
先前的研究对于阿司匹林是否影响结直肠癌（CRC）患者的生存率产生了相互矛盾的结果。本研究在全国队列中探讨了CRC患者定期使用阿司匹林与生存率之间的关系。
通过冰岛癌症登记处识别出2000年至2019年在冰岛被诊断为CRC的所有患者。从医疗记录中提取包括用药情况在内的临床变量。计算总生存期（OS）和癌症特异性生存期（CSS）。随访期至2022年10月1日结束。使用Charlson合并症指数评估合并症负担，并采用倾向评分匹配来平衡患者特征。
在2561名符合条件的患者中，22%（n = 559）在CRC诊断前一直在服用阿司匹林。阿司匹林使用者通常年龄较大，男性比例更高（63%对51%），合并症负担更高（15%对4.7%）。中位随访期为51个月（IQR 14 - 110）。阿司匹林使用者接受IV期诊断的可能性较小。匹配后，阿司匹林使用者和非使用者的总生存期（OS）相当（HR：0.94，95%CI（0.83 - 1.06），P = 0.30）。然而，阿司匹林使用者的癌症特异性生存期（CSS）明显更好（HR：0.79，95%CI（0.65 - 0.95），P = 0.01）。在I - III期CRC患者或因胃肠道出血而诊断的患者中未观察到这种益处。
使用阿司匹林与改善CSS相关，但与OS无关。研究结果表明阿司匹林在减缓或阻碍进展至IV期癌症方面具有潜在作用。
