JAMA Netw Open:阿司匹林的使用与老年患者癌症发病率和生存率的评价

2021-01-18 MedSci原创 MedSci原创

研究结果进一步证明了阿司匹林可以提高某些癌症患者的生存率。

对于50 - 59岁血管疾病高风险人群,指南推荐阿司匹林作为心血管疾病的一级预防,同时还可降低结肠直肠癌风险。然而,对于60 - 69岁的人,建议是基于个体化的风险-益处分析,对于50岁以下或70岁以上的人,数据很有限。尽管存在潜在风险,美国25%至50%的成年人报告每天或每隔一天服用阿司匹林,使用量随年龄增长而增加。长期服用阿司匹林与心脏病、中风、癌症(特别是胃肠道癌症)和全因死亡率的降低相关。

考虑到阿司匹林非选择性地抑制环氧合酶,从而抑制炎症,长期服用阿司匹林可能会影响癌症的发生。最近的大规模评估表明,几种肿瘤类型的免疫细胞活性异常,包括膀胱、乳腺、胃和子宫肿瘤,为阿司匹林的活性提供了主要靶点。此外,阿司匹林的使用已被证明会影响癌症诊断后的生存率,尽管数据仍然不一。

有研究者在膀胱癌、乳腺癌、食道癌、胃癌胰腺癌和子宫癌患者中,研究了阿司匹林与发生癌症的风险以及肿瘤部位特异性生存率的相关性。该研究结果发表在JAMA Netw Open杂志上。

这项队列研究使用了前列腺癌、肺癌、结直肠癌卵巢癌筛查试验的数据。受试者基线年龄为65岁或以上(1993-2001),随访年龄为65岁。数据分析于2020年1月至6月进行。主要结局为研究癌症类型的发病率和生存率。采用Cox比例风险回归模型计算单变量和多变量风险比(HRs)以及95%可信区间,并调整协变量。发病率的多变量模型包括时变协变量。

研究结果显示,共有139896人被纳入分析(基线时的平均[SD]年龄,66.4[2.4]岁;71884[51.4%]妇女;123824[88.5%]非西班牙裔白人)。在研究期间,报告了32580例癌症(1751例[5.4%]膀胱癌,4552例[14.0%]乳腺癌,332例[1.0%]食管癌,397例[1.2%]胃癌,878例[2.7%]胰腺癌和716例[2.2%]子宫癌)。在65岁或65岁以上的人群中,阿司匹林的使用与所研究的任何癌症类型的发病率无关。多变量回归分析表明,每周至少服用3次阿司匹林与膀胱癌(HR,0.67;95%CI,0.51-0.88)和乳腺癌(HR,0.75;95%CI,0.59-0.96)患者的生存率增加有关,但与食管癌、胃癌、胰腺癌或子宫癌患者的生存率无关。使用阿司匹林与膀胱癌(HR,0.75;95%CI,0.58-0.98)和乳腺癌(HR,0.79;95%CI,0.63-0.99)的生存率有相似的关系。


在前列腺癌、肺癌、结直肠癌和卵巢癌筛查试验中使用阿司匹林对癌症生存率的校正危险比(HRs)和95%CIs

总之,在PLCO癌症筛查试验中,本研究未发现阿司匹林使用与膀胱癌、乳腺癌、食道癌、胃癌、胰腺癌或子宫癌发病率之间的相关性。研究者确实发现了服用阿司匹林与膀胱癌和乳腺癌生存率之间的正相关关系,尽管这在食管癌、胃癌、胰腺癌和子宫癌生存率中未见明显。研究结果进一步证明了阿司匹林可以提高某些癌症患者的生存率。虽然先前的研究主要集中在胃肠道癌症,但本分析将阿司匹林的使用优势扩展到其他癌症,如膀胱癌和乳腺癌。然而,尽管服用阿司匹林可能会有防癌作用,但长期服用阿司匹林的益处和危害仍然是必须考虑的。

参考文献:Loomans-Kropp HA, Pinsky P, Umar A. Evaluation of Aspirin Use With Cancer Incidence and Survival Among Older Adults in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. JAMA Netw Open. 2021;4(1):e2032072. doi:10.1001/jamanetworkopen.2020.32072

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createdName=旺医, createdTime=Mon Jan 18 19:53:32 CST 2021, time=2021-01-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=917793, encodeId=b10691e7936a, content=很好的, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e56b5453857, createdName=ms2000000474051546, createdTime=Mon Jan 18 18:13:38 CST 2021, time=2021-01-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=917783, encodeId=0bd291e7833d, content=<a href='/topic/show?id=51639e734cb' target=_blank style='color:#2F92EE;'>#阿司匹林#</a>使用与<a href='/topic/show?id=843a85e9421' target=_blank style='color:#2F92EE;'>#膀胱癌#</a>、<a href='/topic/show?id=73c423e2572' target=_blank style='color:#2F92EE;'>#乳腺癌#</a>、<a href='/topic/show?id=1de610116073' target=_blank style='color:#2F92EE;'>#食道癌#</a>、胃癌、胰腺癌或子宫癌发病率之间的相关性, beContent=null, 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  4. 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    2021-03-17 SDetector

    神药养活了多少水耗子

    0

  5. 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createdName=SDetector, createdTime=Wed Mar 17 08:41:02 CST 2021, time=2021-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1256806, encodeId=01f612568066b, content=<a href='/topic/show?id=43706900963' target=_blank style='color:#2F92EE;'>#生存率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69009, encryptionId=43706900963, topicName=生存率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6a6043, createdName=guoyibin, createdTime=Wed Jan 20 07:53:32 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1444673, encodeId=9c3414446e3cf, content=<a href='/topic/show?id=3d9291459d1' target=_blank style='color:#2F92EE;'>#评价#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91459, encryptionId=3d9291459d1, topicName=评价)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1fee5134542, createdName=huagfeg, createdTime=Wed Jan 20 07:53:32 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=917838, encodeId=18d891e838c1, content=感谢感谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=27245137967, createdName=1466d939m82暂无昵称, createdTime=Mon Jan 18 19:57:26 CST 2021, time=2021-01-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036402, encodeId=25761036402ab, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, 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  6. 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encryptionId=3d9291459d1, topicName=评价)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1fee5134542, createdName=huagfeg, createdTime=Wed Jan 20 07:53:32 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=917838, encodeId=18d891e838c1, content=感谢感谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=27245137967, createdName=1466d939m82暂无昵称, createdTime=Mon Jan 18 19:57:26 CST 2021, time=2021-01-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036402, encodeId=25761036402ab, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, 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    2021-01-20 huagfeg
  7. [GetPortalCommentsPageByObjectIdResponse(id=1728782, encodeId=23b41e2878288, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Wed Jun 30 09:53:32 CST 2021, time=2021-06-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1734293, encodeId=e5b01e34293de, content=<a href='/topic/show?id=d4f412668a4' target=_blank style='color:#2F92EE;'>#NET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12668, encryptionId=d4f412668a4, topicName=NET)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7ea033781210, createdName=canlab, createdTime=Sat May 08 22:53:32 CST 2021, time=2021-05-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1823693, encodeId=1efa182369309, content=<a href='/topic/show?id=b2873e9220e' target=_blank style='color:#2F92EE;'>#发病率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37922, encryptionId=b2873e9220e, topicName=发病率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aa0e14, createdName=lifestar, createdTime=Sat Jul 17 03:53:32 CST 2021, time=2021-07-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=948920, encodeId=64039489207b, content=神药养活了多少水耗子, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=297f5135957, 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encryptionId=3d9291459d1, topicName=评价)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1fee5134542, createdName=huagfeg, createdTime=Wed Jan 20 07:53:32 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=917838, encodeId=18d891e838c1, content=感谢感谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=27245137967, createdName=1466d939m82暂无昵称, createdTime=Mon Jan 18 19:57:26 CST 2021, time=2021-01-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036402, encodeId=25761036402ab, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, 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objectType=article, channel=null, level=null, likeNumber=264, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97734, encryptionId=51639e734cb, topicName=阿司匹林), TopicDto(id=85794, encryptionId=843a85e9421, topicName=膀胱癌), TopicDto(id=23725, encryptionId=73c423e2572, topicName=乳腺癌), TopicDto(id=101160, encryptionId=1de610116073, topicName=食道癌)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211210/ede9c51184aa4f54ae6c1164cfb8eeac/967dbf3eff2943c7bf3ccfec3a776ab0.JPG, createdBy=a33789389, createdName=lifefamily, createdTime=Mon Jan 18 17:13:53 CST 2021, time=2021-01-18, status=1, ipAttribution=)]
    2021-01-18 1466d939m82暂无昵称

    感谢感谢

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1728782, encodeId=23b41e2878288, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Wed Jun 30 09:53:32 CST 2021, time=2021-06-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1734293, encodeId=e5b01e34293de, content=<a href='/topic/show?id=d4f412668a4' target=_blank style='color:#2F92EE;'>#NET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12668, encryptionId=d4f412668a4, topicName=NET)], attachment=null, authenticateStatus=null, createdAvatar=null, 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encryptionId=3d9291459d1, topicName=评价)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1fee5134542, createdName=huagfeg, createdTime=Wed Jan 20 07:53:32 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=917838, encodeId=18d891e838c1, content=感谢感谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=27245137967, createdName=1466d939m82暂无昵称, createdTime=Mon Jan 18 19:57:26 CST 2021, time=2021-01-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036402, encodeId=25761036402ab, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, 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objectType=article, channel=null, level=null, likeNumber=264, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97734, encryptionId=51639e734cb, topicName=阿司匹林), TopicDto(id=85794, encryptionId=843a85e9421, topicName=膀胱癌), TopicDto(id=23725, encryptionId=73c423e2572, topicName=乳腺癌), TopicDto(id=101160, encryptionId=1de610116073, topicName=食道癌)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211210/ede9c51184aa4f54ae6c1164cfb8eeac/967dbf3eff2943c7bf3ccfec3a776ab0.JPG, createdBy=a33789389, createdName=lifefamily, createdTime=Mon Jan 18 17:13:53 CST 2021, time=2021-01-18, status=1, ipAttribution=)]
    2021-01-18 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0

  9. 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encryptionId=3d9291459d1, topicName=评价)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1fee5134542, createdName=huagfeg, createdTime=Wed Jan 20 07:53:32 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=917838, encodeId=18d891e838c1, content=感谢感谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=27245137967, createdName=1466d939m82暂无昵称, createdTime=Mon Jan 18 19:57:26 CST 2021, time=2021-01-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036402, encodeId=25761036402ab, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, 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objectType=article, channel=null, level=null, likeNumber=264, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97734, encryptionId=51639e734cb, topicName=阿司匹林), TopicDto(id=85794, encryptionId=843a85e9421, topicName=膀胱癌), TopicDto(id=23725, encryptionId=73c423e2572, topicName=乳腺癌), TopicDto(id=101160, encryptionId=1de610116073, topicName=食道癌)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211210/ede9c51184aa4f54ae6c1164cfb8eeac/967dbf3eff2943c7bf3ccfec3a776ab0.JPG, createdBy=a33789389, createdName=lifefamily, createdTime=Mon Jan 18 17:13:53 CST 2021, time=2021-01-18, status=1, ipAttribution=)]
    2021-01-18 ms2000000474051546

    很好的

    0

  10. 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    2021-01-18 lifefamily

    #阿司匹林#使用与#膀胱癌##乳腺癌##食道癌#、胃癌、胰腺癌或子宫癌发病率之间的相关性

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