Background & Aims

Preclinical studies have shown aspirin to have anticancer properties and epidemiologic studies have associated aspirin use with longer survival times of patients with cancer. We studied 2 large cohorts to determine the association between aspirin use and cancer-specific mortality in patients with esophageal or gastric cancer.

Methods

We performed a population-based study using cohorts of patients newly diagnosed with esophageal or gastric cancer, identified from cancer registries in England from 1998 through 2012 and the Scottish Cancer Registry from 2009 through 2012. Low-dose aspirin prescriptions were identified from linkages to the United Kingdom Clinical Research Practice Datalink in England and the Prescribing Information System in Scotland. Deaths were identified from linkage to national mortality records, with follow-up until September 2015 in England and January 2015 in Scotland. Time-dependent Cox regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for cancer-specific mortality by low-dose aspirin use after adjusting for potential confounders. Meta-analysis was used to pool results across the 2 cohorts.

Results

The combined English and Scottish cohorts contained 4654 patients with esophageal cancer and 3833 patients with gastric cancer, including 3240 and 2392 cancer-specific deaths, respectively. The proportions surviving 1 year, based on cancer-specific mortality, were similar in aspirin users vs non-users after diagnosis with esophageal cancer (48% vs 50% in England and 49% vs 46% in Scotland, respectively) or gastric cancer (58% vs 57% in England and 59% vs 55% in Scotland, respectively). There was no association between postdiagnosis use of low-dose aspirin and cancer-specific mortality among patients with esophageal cancer (pooled adjusted HR, 0.98; 95% CI, 0.89–1.09) or gastric cancer (pooled adjusted HR, 0.96; 95% CI, 0.85–1.08). Long-term aspirin use was not associated with cancer-specific mortality after diagnosis of esophageal cancer (pooled adjusted HR, 1.03; 95% CI, 0.85–1.25) or gastric cancer (pooled adjusted HR, 1.06; 95% CI, 0.85–1.32).

Conclusions

In analyses of 2 large independent cohorts in the United Kingdom, low-dose aspirin usage was not associated with increased survival of patients diagnosed with esophageal or gastric cancer.

中文翻译：

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小剂量使用阿司匹林并不能增加食管癌或胃癌患者的两个独立人群队列的生存率

背景与目标

临床前研究表明阿司匹林具有抗癌特性，流行病学研究表明阿司匹林的使用与癌症患者更长的生存时间相关。我们研究了2个大型队列，以确定在食道癌或胃癌患者中使用阿司匹林与癌症特异性死亡率之间的关系。

方法

我们进行了一项基于人群的研究，使用了新诊断为食道或胃癌的患者队列，这些患者是从1998年至2012年在英国的癌症登记处和2009年至2012年的苏格兰癌症登记处确定的。英国的英国临床研究实践数据链和苏格兰的处方信息系统。通过与国家死亡率记录的联系确定了死亡人数，对英国的随访至2015年9月，苏格兰的随访至2015年1月。在调整潜在的混杂因素后，通过使用低剂量阿司匹林，使用时间依赖性Cox回归模型来计算特定于癌症的死亡率的危险比（HRs）和95％置信区间（CIs）。荟萃分析用于汇总两个队列的结果。

结果

英格兰和苏格兰的合并队列包括4654例食道癌患者和3833例胃癌患者，其中分别有3240例和2392例癌症特异性死亡。根据癌症特异性死亡率，在诊断为食道癌（分别为48％对50％在英国和49％对46％在苏格兰）后，阿司匹林使用者与非使用者相比，存活1年的比例相似（分别为48％和50％，苏格兰为49％和46％）。分别是英格兰的58％和57％，苏格兰的59％和55％）。食管癌（合并校正后的HR，0.98； 95％CI，0.89–1.09）或胃癌（合并校正后的HR，0.96； 95％CI）的患者，低剂量阿司匹林的诊断后使用与癌症特异性死亡率之间没有关联。 ，0.85–1.08）。

结论

在对英国2个大型独立队列的分析中，低剂量阿司匹林的使用与确诊为食道或胃癌的患者的生存率增加无关。