最新证据:预防消化道癌症,阿司匹林效果如何?
创作:Lexi 审核:Lexi 2020年04月20日
  • 经常服用阿司匹林可降低患结直肠癌(CRC)、鳞状细胞食道癌、食管和贲门腺癌、胃癌、肝胆道癌和胰腺癌的风险,头颈癌除外;
  • 相比同期组和嵌套病例对照组,该相关性在病例对照组中略强,并具有研究间异质性;
  • 性别、地理区域和其他选定协变量之间的风险估计一致;
  • 对于CRC而言,服用阿司匹林的剂量在每天75-100毫克之间可降低10%的风险,服用325毫克/天可降低35%的风险;
  • 除头颈癌之外的所有肿瘤,阿司匹林的使用时间与患癌风险成反比。
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Lexi
阿司匹林被证明可以降低患结直肠癌(CRC)以及其他消化道癌症的风险。但如何量化降低的风险、如何选择阿司匹林最佳剂量和使用时间以预防癌症仍不清楚。为了提供这种相关性的最新量化,最新发表在Annals of Oncology的综述对截至2019年3月发表的关于阿司匹林和消化道癌症的所有观察性研究进行系统回顾和荟萃分析。该研究发现阿司匹林的防癌效果随使用时间的延长而增加,而随着使用阿司匹林的剂量增加,预防结直肠癌的效果也增强。
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Annals of Oncology [IF:18.274]

Aspirin and the risk of colorectal and other digestive tract cancers: an updated meta-analysis through 2019

阿司匹林和结直肠癌及其他消化道癌症的风险:2019年的最新荟萃分析

10.1016/j.annonc.2020.02.012

2020-02-12, Review

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Background: : Aspirin has been associated with a reduced risk of colorectal cancer, and possibly of a few other digestive tract cancers. The quantification of risk reduction and the optimal dose and duration of aspirin use for the prevention of colorectal and other digestive tract cancers remains unclear.
Methods:: To provide an up-to-date quantification of this association, we conducted a systematic review and metaanalysis of all observational studies on aspirin and cancers of the digestive tract sites published through March 2019. We estimated the pooled relative risk (RR) of cancer for regular aspirin use versus non-use using randomeffects models, and, whenever data were available, we investigated the dose- and duration-risk relations.
Results: : Regular aspirin use is associated with a reduced risk of colorectal cancer [RR ¼ 0.73, 95% confidence interval (CI) ¼ 0.69e0.78, 45 studies], squamous-cell esophageal cancer (RR ¼ 0.67, 95% CI ¼ 0.57e0.79, 13 studies), adenocarcinoma of the esophagus and gastric cardia (RR ¼ 0.61, 95% CI ¼ 0.49e0.77, 10 studies), stomach cancer (RR ¼ 0.64, 95% CI ¼ 0.51e0.82, 14 studies), hepato-biliary tract cancer (RR ¼ 0.62, 95% CI ¼ 0.44e0.86, five studies), and pancreatic cancer (RR ¼ 0.78, 95% CI ¼ 0.68e0.89, 15 studies), but not of head and neck cancer (RR ¼ 0.94, 95% CI ¼ 0.76e1.16, 10 studies). The associations are somewhat stronger in case-control than in cohort and nested case-control studies and are characterized by some between-study heterogeneity. Risk estimates are consistent across sex, geographical areas, and other selected covariates. For colorectal cancer, an aspirin dose between 75 and 100 mg/day conveys a risk reduction of 10%, and a dose of 325 mg/day of 35%. For all neoplasms, except head and neck cancer, inverse duration-risk relations with aspirin use are found.
Conclusion: : The present comprehensive meta-analysis supports and further quantifies the inverse association between regular aspirin use and the risk of colorectal and other digestive tract cancers, including some rare ones. The favorable effect of aspirin increases with longer duration of use, and, for colorectal cancer, with increasing dose. Key words: aspirin, colorectal neoplasm, digestive tract neoplasm, dose, duration, meta-analysis, risk factor

First Authors:
C Bosetti

Correspondence Authors:
C Bosetti

All Authors:
C Bosetti,C Santucci,S Gallus,M Martinetti,C La Vecchia

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