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Association of Aspirin with Hepatocellular Carcinoma and Liver-Related Mortality.
The New England Journal of Medicine ( IF 158.5 ) Pub Date : 2020-03-12 , DOI: 10.1056/nejmoa1912035
Tracey G Simon 1 , Ann-Sofi Duberg 1 , Soo Aleman 1 , Raymond T Chung 1 , Andrew T Chan 1 , Jonas F Ludvigsson 1
Affiliation  

Background

More information is needed about the long-term effects of low-dose aspirin (≤160 mg) on incident hepatocellular carcinoma, liver-related mortality, and gastrointestinal bleeding in persons with chronic hepatitis B or hepatitis C virus infection.

Methods

Using nationwide Swedish registries, we identified all adults who received a diagnosis of chronic hepatitis B or hepatitis C from 2005 through 2015 and who did not have a history of aspirin use (50,275 patients). Patients who were starting to take low-dose aspirin (14,205 patients) were identified by their first filled prescriptions for 90 or more consecutive doses of aspirin. We constructed a propensity score and applied inverse probability of treatment weighting to balance baseline characteristics between groups. Using Cox proportional-hazards regression modeling, we estimated the risk of hepatocellular carcinoma and liver-related mortality, accounting for competing events.

Results

With a median of 7.9 years of follow-up, the estimated cumulative incidence of hepatocellular carcinoma was 4.0% among aspirin users and 8.3% among nonusers of aspirin (difference, −4.3 percentage points; 95% confidence interval [CI], −5.0 to −3.6; adjusted hazard ratio, 0.69; 95% CI, 0.62 to 0.76). This inverse association appeared to be duration-dependent; as compared with short-term use (3 months to <1 year), the adjusted hazard ratios were 0.90 (95% CI, 0.76 to 1.06) for 1 to less than 3 years of use, 0.66 (95% CI, 0.56 to 0.78) for 3 to less than 5 years of use, and 0.57 (95% CI, 0.42 to 0.70) for 5 or more years of use. Ten-year liver-related mortality was 11.0% among aspirin users and 17.9% among nonusers (difference, −6.9 percentage points [95% CI, −8.1 to −5.7]; adjusted hazard ratio, 0.73 [95% CI, 0.67 to 0.81]). However, the 10-year risk of gastrointestinal bleeding did not differ significantly between users and nonusers of aspirin (7.8% and 6.9%, respectively; difference, 0.9 percentage points; 95% CI, −0.6 to 2.4).

Conclusions

In a nationwide study of patients with chronic viral hepatitis in Sweden, use of low-dose aspirin was associated with a significantly lower risk of hepatocellular carcinoma and lower liver-related mortality than no use of aspirin, without a significantly higher risk of gastrointestinal bleeding. (Funded by the National Institutes of Health and others.)



中文翻译:

阿司匹林与肝细胞癌和肝相关死亡率的关联。

背景

需要更多有关低剂量阿司匹林(≤160mg)对慢性乙型肝炎或丙型肝炎病毒感染者肝细胞癌,肝脏相关死亡率和胃肠道出血的长期影响的信息。

方法

我们使用瑞典全国登记册,确定了从2005年至2015年被诊断出患有慢性乙型或丙型肝炎且无阿司匹林使用史的所有成年人(50,275名患者)。开始服用小剂量阿司匹林的患者(14,205名患者)通过首次连续开具90或更多剂量阿司匹林的处方来确定。我们构建了倾向得分,并应用了治疗加权的逆概率来平衡组之间的基线特征。使用Cox比例风险回归模型,我们考虑了竞争事件,估计了肝细胞癌的风险和与肝脏相关的死亡率。

结果

平均随访7.9年,阿司匹林使用者中肝细胞癌的累计累积发生率估计为4.0%,非使用者中为8.3%(差异为-4.3个百分点; 95%置信区间[CI]为-5.0 −3.6;调整后的危险比为0.69; 95%CI为0.62至0.76)。这种反相关似乎与持续时间有关;与短期使用(3个月至<1年)相比,使用不到1年至3年的调整后危险比为0.90(95%CI,0.76至1.06),0.66(95%CI,0.56至0.78) )使用3至少于5年,使用0.57(95%CI,0.42至0.70)使用5年或更长时间。服用阿司匹林的十年肝相关死亡率为11.0%,非服用者为17.9%(差异为-6.9个百分点[95%CI,-8.1至-5.7];调整后的危险比为0.73 [95%CI,0.67至0.81] ])。然而,

结论

在瑞典进行的一项全国慢性病毒性肝炎患者研究中,与不使用阿司匹林相比,使用低剂量阿司匹林显着降低了肝细胞癌的风险,降低了与肝脏相关的死亡率,并且没有明显增加胃肠道出血的风险。(由美国国立卫生研究院和其他机构资助。)

更新日期:2020-03-12
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