J Natl Cancer Inst:阿司匹林怎么吃、什么时候开始吃、吃多久可预防结直肠癌?

2021-02-04 Nebula MedSci原创

阿司匹林可预防结直肠癌,该怎么吃、什么时候开始吃、吃多久呢?

全球都面临很重的结直肠癌疾病负担,结直肠癌占新确诊癌症病例的10%,贡献了9%的癌症相关死亡。阿司匹林是最有希望的结直肠癌化学预防药物。然而,既往流行病学和干预研究都还未能分离阿司匹林在结直肠癌化学预防中的剂量、时间和持续时间的独立效应。

本研究在“护士健康研究”和“卫生专业人员随访研究”中根据时间分析了以阿司匹林为基础的结直肠癌化学预防的各种指标。

考虑到新发腺瘤进展成结直肠癌通常至少需要10年,研究人员以10年为分割线,将暴露指标定为随访开始10年前(长期)和随访开始前10?年内(短期)内阿司匹林的累积平均剂量和总持续时间。采用Cox模型估计暴露和结直肠癌风险的危险比(HR)和95%置信区间(CI)。

在随访前,阿司匹林已使用10年以上时间(每增加5年的HR 0.88,95%CI 0.83~0.94)和刚满10年(HR 0.90,95%CI 0.84~0.96)在结直肠癌化学预防中同样重要,但近期需要用满5年才能展现出结直肠癌预防作用。在长期患者队列中,阿司匹林对结直肠癌的预防作用不是剂量依赖性的;与<0.50标准(325 mg)-剂量片剂/周相比;阿司匹林剂量为0.5-<1.5、1.5-<5和5片剂/周时的HR分别为0.78(95%CI 0.6 3~0.98)、0.81(0.72~0.91)和0.74(0.6 4~0.86)。

但是,在短期患者队列中,阿司匹林对结直肠癌的预防效果存在一定剂量依赖性(上述三个剂量水平的HR分别为0.91[0.79~1.06]、0.87[0.77~0.98]和0.76[0.64~0.91])。

总而言之,阿司匹林需至少持续服用6-10年才能具有明显的预防结直肠癌的作用,最明显的是连用10年。远期使用和在过去10年内使用都与结直肠癌风险降低独立相关,但长期使用时只需要很低的剂量即可获得临床效益。

原始出处:

Zhang Yin,Chan Andrew T,Meyerhardt Jeffrey A et al. Timing of aspirin use in colorectal cancer chemoprevention: a prospective cohort study.[J] .J Natl Cancer Inst, 2021, https://doi.org/10.1093/jnci/djab009.

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    2021-04-24 liye789132251
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    2021-02-09 qidongfanjian
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    2021-02-04 T2DM终结者

    阿司匹林预防结直肠癌 连续用药6-10年,应该从中青年人群就开始推广

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