Effect of daily aspirin on long-term risk of death due to cancer: analysis of individual patient data from randomised trials
Effect of daily aspirin on long-term risk of death due to cancer: analysis of individual patient data from randomised trials
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DOI：
10.1016/s0140-6736(10)62110-1
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发表时间：
2011-01-01
期刊：
影响因子：
168.9
通讯作者：
Meade, Tom W.
中科院分区：
文献类型：
--
作者：
Rothwell, Peter M.;Fowkes, F. Gerald R.;Meade, Tom W.
每日服用阿司匹林5年或更长时间可降低结直肠癌的后续风险。一些证据表明，阿司匹林也可能降低患其他癌症的风险，特别是胃肠道癌症，但缺乏人体证据。我们研究了每日服用阿司匹林与对照药物预防血管事件的随机试验期间和之后的癌症死亡。方法我们使用了每日服用阿司匹林与不服用阿司匹林的所有随机试验的个体患者数据，平均试验治疗时间为4年或更长，以确定分配给阿司匹林对癌症死亡风险的影响，胃肠道和非胃肠道癌症。在三个大的英国试验中，长期的试验后随访的个别患者获得的死亡证明和癌症registrations.Results在8个合格的试验（25 570例患者，674癌症死亡），分配到阿司匹林减少因癌症死亡（合并优势比[OR] 0.79，95%CI 0.68-0.92，p=0.003）。对7项试验（23535例患者，657例癌症死亡）中的个体患者数据进行分析，仅在5年随访后获益明显（所有癌症，风险比[HR] 0.66，0.50-0.87;胃肠道癌症，0.46，0.27-0.77;均p=0.003）。阿司匹林组20年癌症死亡风险（三项试验中12659例患者中1634例死亡）仍低于对照组（所有实体癌，HR 0.80，0.72-0.88，p
Background Treatment with daily aspirin for 5 years or longer reduces subsequent risk of colorectal cancer. Several lines of evidence suggest that aspirin might also reduce risk of other cancers, particularly of the gastrointestinal tract, but proof in man is lacking. We studied deaths due to cancer during and after randomised trials of daily aspirin versus control done originally for prevention of vascular events.Methods We used individual patient data from all randomised trials of daily aspirin versus no aspirin with mean duration of scheduled trial treatment of 4 years or longer to determine the effect of allocation to aspirin on risk of cancer death in relation to scheduled duration of trial treatment for gastrointestinal and non-gastrointestinal cancers. In three large UK trials, long-term post-trial follow-up of individual patients was obtained from death certificates and cancer registries.Results In eight eligible trials (25 570 patients, 674 cancer deaths), allocation to aspirin reduced death due to cancer (pooled odds ratio [OR] 0.79, 95% CI 0.68-0.92, p=0.003). On analysis of individual patient data, which were available from seven trials (23 535 patients, 657 cancer deaths), benefit was apparent only after 5 years' follow-up (all cancers, hazard ratio [HR] 0.66, 0.50-0.87; gastrointestinal cancers, 0.46, 0.27-0.77; both p=0.003). The 20-year risk of cancer death (1634 deaths in 12 659 patients in three trials) remained lower in the aspirin groups than in the control groups (all solid cancers, HR 0.80, 0.72-0.88, p