J Natl Cancer Inst:确诊结直肠癌后再吃阿司匹林是否还能降低患者的死亡风险?

2021-02-04 MedSci原创 MedSci原创

确诊CRC后再服用阿司匹林是否还能获得生存益处?

既往研究表明,长期服用阿司匹林可降低结直肠癌(CRC)的发病风险,但确诊CRC后再服用阿司匹林是否还能获得生存益处尚不明确。此外,服用非阿司匹林非甾体抗炎药(NSAID)是否有同样的效果也无相关数据。

这项前瞻性分析纳入了癌症预防研究-II营养队列中在基线(1992年-1993年)时没有癌症,并在2015年之前的随访中被诊断为CRC的受试者。关于阿司匹林和非阿司匹林NSAID使用的详细信息采用调查问卷进行自我报告,每2年进行一次。分别有2686名和1931名没有远处转移的受试者有确诊前和确诊后的数据,其中分别有512人和251人在截至2016年的随访期间死于CRC。

受试患者确诊CRC时平均73.5岁,常规使用阿司匹林的患者更多有血管疾病(CVD)和或糖尿病病史,多同时服用氯吡格雷干预。

无论是在确诊CRC前还是入组时开始长期定期(≥15次/月)服用阿司匹林均可显著降低CRC特异性死亡率(多变量调整后的风险比 HR 0.69)。虽然在确诊后才开始定期服用阿司匹林的受试者比那些在确诊前后都没有使用阿司匹林的受试者的CRC特异性死亡风险更低,但确诊CRC后,无论是服用阿司匹林还是非阿司匹林NSAID都不能再明显降低CRC特异性死亡率(平均随访9.4年;HR 0.82)。长期使用阿司匹林还与罹患结直肠癌后发生远处转移的几率较低有关(多变量调整后的HR 0.73)。

该研究结果表明,非转移性结直肠癌患者在确诊前长期服用阿司匹林可能与确诊后较低的CRC特异性死亡率有关,这与确诊前可能抑制微转移是一致的。确诊结直肠癌后再吃阿司匹林不能明显降低患者的死亡风险。

原始出处:

Figueiredo Jane C,Jacobs Eric J,Newton Christina C et al. Associations of aspirin and non-aspirin non-steroidal anti-inflammatory drugs with colorectal cancer mortality after diagnosis. J Natl Cancer Inst, 2021, https://doi.org/10.1093/jnci/djab008

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    2021-05-27 qidongfanjian
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    2022-01-08 drj2003
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    2022-01-02 liye789132251
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channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKibA62IFMeUJEmSyIe8DvYFeERuOsfrRd8iano7nENqQU1dRR3tqeQOUL3eqgYgEZRT2t2iaEsib0JEw/132, createdBy=66771693911, createdName=易水河, createdTime=Thu Feb 04 16:03:29 CST 2021, time=2021-02-04, status=1, ipAttribution=)]
  6. 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content=阿司匹林感觉被神化了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4b192480386, createdName=用户被禁用, createdTime=Thu Feb 04 19:02:11 CST 2021, time=2021-02-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922823, encodeId=4b32922823bb, content=写的很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210803/18a80d2367814f61bbe4c923e65f1d98/16479f926d194fa8a9ea5e1f2e022e9b.jpg, createdBy=e1981971406, createdName=1e1606abm78(暂无匿称), createdTime=Thu Feb 04 16:08:30 CST 2021, time=2021-02-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922820, encodeId=f7b29228208c, content=阿司匹林真是好药啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKibA62IFMeUJEmSyIe8DvYFeERuOsfrRd8iano7nENqQU1dRR3tqeQOUL3eqgYgEZRT2t2iaEsib0JEw/132, createdBy=66771693911, createdName=易水河, createdTime=Thu Feb 04 16:03:29 CST 2021, time=2021-02-04, status=1, ipAttribution=)]
    2021-02-05 Jessica

    非转移性结直肠癌患者在确诊前长期服用阿司匹林可能与确诊后较低的CRC特异性死亡率有关,确诊结直肠癌后再吃阿司匹林不能明显降低患者的死亡风险。

    0

  7. 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encryptionId=587f6339050, topicName=死亡风险)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Sat Feb 06 06:47:41 CST 2021, time=2021-02-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1453469, encodeId=59c4145346941, content=<a href='/topic/show?id=098ee8679ad' target=_blank style='color:#2F92EE;'>#结直肠#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78679, encryptionId=098ee8679ad, topicName=结直肠)], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=9ace5575596, createdName=crystal0564, createdTime=Sat Feb 06 06:47:41 CST 2021, time=2021-02-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922991, encodeId=8caf92299197, content=非转移性结直肠癌患者在确诊前长期服用阿司匹林可能与确诊后较低的CRC特异性死亡率有关,确诊结直肠癌后再吃阿司匹林不能明显降低患者的死亡风险。 , beContent=null, 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content=阿司匹林感觉被神化了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4b192480386, createdName=用户被禁用, createdTime=Thu Feb 04 19:02:11 CST 2021, time=2021-02-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922823, encodeId=4b32922823bb, content=写的很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210803/18a80d2367814f61bbe4c923e65f1d98/16479f926d194fa8a9ea5e1f2e022e9b.jpg, createdBy=e1981971406, createdName=1e1606abm78(暂无匿称), createdTime=Thu Feb 04 16:08:30 CST 2021, time=2021-02-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922820, encodeId=f7b29228208c, content=阿司匹林真是好药啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKibA62IFMeUJEmSyIe8DvYFeERuOsfrRd8iano7nENqQU1dRR3tqeQOUL3eqgYgEZRT2t2iaEsib0JEw/132, createdBy=66771693911, createdName=易水河, createdTime=Thu Feb 04 16:03:29 CST 2021, time=2021-02-04, status=1, ipAttribution=)]
    2021-02-05 神盾医疗局局长Jack

    老药新用

    0

  8. 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objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211019/df01a4bfb64246379ddfef3370d04115/e1274c8eb5e440918f56f83bcfea9031.jpg, createdBy=3a345397082, createdName=Jessica, createdTime=Fri Feb 05 10:31:33 CST 2021, time=2021-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922976, encodeId=88539229e6ea, content=老药新用, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200529/3611e9bb629c4e5b81fbd8ce784b06cc/128487eae357460bb98f67d86230c218.jpg, createdBy=ab235268530, createdName=神盾医疗局局长Jack, createdTime=Fri Feb 05 09:54:21 CST 2021, time=2021-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922853, encodeId=a8a292285388, content=阿司匹林感觉被神化了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4b192480386, createdName=用户被禁用, createdTime=Thu Feb 04 19:02:11 CST 2021, time=2021-02-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922823, encodeId=4b32922823bb, content=写的很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210803/18a80d2367814f61bbe4c923e65f1d98/16479f926d194fa8a9ea5e1f2e022e9b.jpg, createdBy=e1981971406, createdName=1e1606abm78(暂无匿称), createdTime=Thu Feb 04 16:08:30 CST 2021, time=2021-02-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922820, encodeId=f7b29228208c, content=阿司匹林真是好药啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKibA62IFMeUJEmSyIe8DvYFeERuOsfrRd8iano7nENqQU1dRR3tqeQOUL3eqgYgEZRT2t2iaEsib0JEw/132, createdBy=66771693911, createdName=易水河, createdTime=Thu Feb 04 16:03:29 CST 2021, time=2021-02-04, status=1, ipAttribution=)]
    2021-02-04 用户被禁用

    阿司匹林感觉被神化了!

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=1950256, encodeId=7169195025677, content=<a href='/topic/show?id=f3b329482a' target=_blank style='color:#2F92EE;'>#ATL#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2948, encryptionId=f3b329482a, topicName=ATL)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b09892, createdName=qidongfanjian, createdTime=Thu May 27 17:47:41 CST 2021, time=2021-05-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1977601, encodeId=341119e76018a, content=<a href='/topic/show?id=d9e5130962f' target=_blank style='color:#2F92EE;'>#NST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13096, encryptionId=d9e5130962f, topicName=NST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=80c5136, createdName=drj2003, createdTime=Sat Jan 08 22:47:41 CST 2022, time=2022-01-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1884959, encodeId=31fe188495957, content=<a href='/topic/show?id=3b2112532d8' target=_blank style='color:#2F92EE;'>#Nat#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12532, encryptionId=3b2112532d8, topicName=Nat)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e6f107, createdName=liye789132251, createdTime=Sun Jan 02 09:47:41 CST 2022, time=2022-01-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1256053, encodeId=c906125605355, content=<a href='/topic/show?id=587f6339050' target=_blank style='color:#2F92EE;'>#死亡风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63390, 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objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211019/df01a4bfb64246379ddfef3370d04115/e1274c8eb5e440918f56f83bcfea9031.jpg, createdBy=3a345397082, createdName=Jessica, createdTime=Fri Feb 05 10:31:33 CST 2021, time=2021-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922976, encodeId=88539229e6ea, content=老药新用, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200529/3611e9bb629c4e5b81fbd8ce784b06cc/128487eae357460bb98f67d86230c218.jpg, createdBy=ab235268530, createdName=神盾医疗局局长Jack, createdTime=Fri Feb 05 09:54:21 CST 2021, time=2021-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922853, encodeId=a8a292285388, content=阿司匹林感觉被神化了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4b192480386, createdName=用户被禁用, createdTime=Thu Feb 04 19:02:11 CST 2021, time=2021-02-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922823, encodeId=4b32922823bb, content=写的很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210803/18a80d2367814f61bbe4c923e65f1d98/16479f926d194fa8a9ea5e1f2e022e9b.jpg, createdBy=e1981971406, createdName=1e1606abm78(暂无匿称), createdTime=Thu Feb 04 16:08:30 CST 2021, time=2021-02-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922820, encodeId=f7b29228208c, content=阿司匹林真是好药啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKibA62IFMeUJEmSyIe8DvYFeERuOsfrRd8iano7nENqQU1dRR3tqeQOUL3eqgYgEZRT2t2iaEsib0JEw/132, createdBy=66771693911, createdName=易水河, createdTime=Thu Feb 04 16:03:29 CST 2021, time=2021-02-04, status=1, ipAttribution=)]
    2021-02-04 1e1606abm78(暂无匿称)

    写的很好

    0

  10. 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objectType=article, channel=null, level=null, likeNumber=74, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211019/df01a4bfb64246379ddfef3370d04115/e1274c8eb5e440918f56f83bcfea9031.jpg, createdBy=3a345397082, createdName=Jessica, createdTime=Fri Feb 05 10:31:33 CST 2021, time=2021-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922976, encodeId=88539229e6ea, content=老药新用, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200529/3611e9bb629c4e5b81fbd8ce784b06cc/128487eae357460bb98f67d86230c218.jpg, createdBy=ab235268530, createdName=神盾医疗局局长Jack, createdTime=Fri Feb 05 09:54:21 CST 2021, time=2021-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922853, encodeId=a8a292285388, content=阿司匹林感觉被神化了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4b192480386, createdName=用户被禁用, createdTime=Thu Feb 04 19:02:11 CST 2021, time=2021-02-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922823, encodeId=4b32922823bb, content=写的很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210803/18a80d2367814f61bbe4c923e65f1d98/16479f926d194fa8a9ea5e1f2e022e9b.jpg, createdBy=e1981971406, createdName=1e1606abm78(暂无匿称), createdTime=Thu Feb 04 16:08:30 CST 2021, time=2021-02-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922820, encodeId=f7b29228208c, content=阿司匹林真是好药啊, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKibA62IFMeUJEmSyIe8DvYFeERuOsfrRd8iano7nENqQU1dRR3tqeQOUL3eqgYgEZRT2t2iaEsib0JEw/132, createdBy=66771693911, createdName=易水河, createdTime=Thu Feb 04 16:03:29 CST 2021, time=2021-02-04, status=1, ipAttribution=)]
    2021-02-04 易水河

    阿司匹林真是好药啊

    0

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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?

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?

Cell Death Differ:PARP1、MRE11和RAD51共同影响结直肠癌肿瘤干细胞的DNA复制应激和有丝分裂

包括结直肠癌(CRC)在内的大多数人实体瘤表现出了在基因、表观遗传、转录和/或表型水平上的患者之间以及肿瘤内的较大的异质性,这也是癌症治疗和患者生存的主要障碍。

JAMA Oncology:阿司匹林能否降低老年人结直肠癌风险?取决于他们何时开始用药

常规使用阿司匹林与降低的结直肠癌风险有关。但是,这一优势仅在70岁之前开始服用阿司匹林的人群中才有意义。

J Clin Oncol:基于分子和临床病理特征的临床计算器可预测I-III期结肠癌术后的复发风险

因为可对患者提供最个性化和最准确的预后估计,临床计算器和诺模图(nomogram)已经得到美国癌症联合委员会(AJCC)的认可。利用分子和临床病理变量,Weiser等人建立了第三代临床计算器来预测I-

Lancet Gastroen Hepatol:新冠肺炎疫情对英国结直肠癌患者诊断及治疗的影响

新冠肺炎疫情导致英国结直肠癌患者的转诊、诊断和治疗受到持续影响