BACKGROUND Accumulating evidence suggests that aspirin use may improve survival in cancer patients, however, for endometrial cancer, epidemiological evidence is limited and results are equivocal. In a nationwide cohort study, we examined the association between post-diagnostic low-dose aspirin use and endometrial cancer mortality. METHODS From the Danish Cancer Registry, we identified all women with a primary diagnosis of endometrial cancer. Women diagnosed between 2000 and 2012, aged 30-84 years, who had no history of cancer (except non-melanoma skin cancer) and were alive 1 year after the cancer diagnosis were eligible. We obtained information on pre- and post-diagnostic use (≥1 prescription) of low-dose aspirin, mortality and potential confounding factors from nationwide registries. Using Cox regression models, we estimated adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between post-diagnostic low-dose aspirin use and endometrial cancer mortality. The exposure was modelled as both time-varying as well as time-fixed within exposure windows of 1 and 5 years. RESULTS We identified 6694 endometrial cancer patients with a maximum follow-up of 13 years. In the time-varying analysis, post-diagnostic low-dose aspirin use was associated with a HR of 1.10 (95% CI 0.90-1.33) for endometrial cancer mortality. We found no indication of a dose-response association according to increasing tablet strength, cumulative amount or duration of use, and the HRs were similar for pre-diagnostic and post-diagnostic low-dose aspirin use compared with non-use. CONCLUSIONS We found no indication that post-diagnostic low-dose aspirin use was associated with reduced mortality for endometrial cancer; rather our findings suggested a concern for increased mortality.

中文翻译：

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低剂量阿司匹林的使用和子宫内膜癌的死亡率-丹麦一项全国性队列研究。

背景技术越来越多的证据表明，使用阿司匹林可以改善癌症患者的生存率，但是，对于子宫内膜癌，流行病学证据有限并且结果是模棱两可的。在一项全国性队列研究中，我们检查了诊断后低剂量阿司匹林的使用与子宫内膜癌死亡率之间的关系。方法从丹麦癌症登记处，我们鉴定出所有具有子宫内膜癌初步诊断的妇女。在2000年至2012年之间诊断，年龄在30-84岁之间，无癌症史（非黑色素瘤皮肤癌除外）且在癌症诊断后存活1年的女性为合格对象。我们从全国注册管理机构获得了有关低剂量阿司匹林的诊断前和诊断后使用（≥1处方），死亡率和潜在混杂因素的信息。使用Cox回归模型，我们估计了诊断后低剂量阿司匹林的使用与子宫内膜癌死亡率之间的关系，并调整了调整后的危险比（HRs）和95％置信区间（CIs）。暴露被建模为随时间变化以及固定在1年和5年暴露窗口内的时间。结果我们确定了6694名子宫内膜癌患者，最长随访时间为13年。在随时间变化的分析中，诊断后低剂量阿司匹林的使用与子宫内膜癌死亡率的1.10（95％CI 0.90-1.33）HR相关。我们发现，随着片剂强度，累积使用量或使用时间的增加，没有剂量反应相关的迹象，诊断前和诊断后低剂量阿司匹林的使用率与未使用时相似。结论我们没有发现低剂量阿司匹林用于诊断性子宫内膜癌的死亡率降低的迹象。相反，我们的发现表明人们担心会增加死亡率。