Nonsteroidal anti-inflammatory drugs, especially aspirin, are linked to lower risk and better survival of hepatocellular carcinoma: a meta-analysis.
Nonsteroidal anti-inflammatory drugs, especially aspirin, are linked to lower risk and better survival of hepatocellular carcinoma: a meta-analysis.
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非甾体抗炎药，尤其是阿司匹林，与降低肝细胞癌风险和提高生存率有关：一项荟萃分析
DOI：
10.2147/cmar.s167560
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发表时间：
2018
影响因子：
3.3
通讯作者：
Yang Z
中科院分区：
文献类型：
--
作者：
Tao Y;Li Y;Liu X;Deng Q;Yu Y;Yang Z
目的非甾体类抗炎药（NSAIDs）在肝细胞癌（HCC）发生和预后中的作用仍存在争议。本分析旨在总结NSAID与HCC发生的关系。方法对PubMed、Embase、奥维德、Web of Science和科克伦图书馆数据库中2017年10月1日前发表的研究进行系统检索和分析。结果共纳入11篇文献。对5项研究的荟萃分析显示，阿司匹林可显著降低HCC发生的风险（风险比[HR] = 0.64，95%置信区间[CI] = 0.45-0.91，P = 0.014）。NSAID（6项研究）和非阿司匹林NSAID（3项研究）的使用在HCC发生率方面无显著差异（分别为HR = 0.74，95%CI = 0.53-1.02，P = 0.064和HR = 0.98，95%CI = 0.87-1.12，P = 0.81）。队列研究的亚组分析显示，NSAID组HCC发生率显著降低（HR = 0.58，95%CI = 0.43-0.78，P < 0.001）。与非NSAID使用者相比，接受NSAID治疗的HCC患者获得了更好的无病生存率和总生存率（分别为HR = 0.79，95%CI = 0.74-0.84，P<0.001和HR = 0.60，95%CI = 0.50-0.72，P<0.001）。此外，两项研究的荟萃分析显示，阿司匹林治疗肝癌患者可显著降低2年和4年死亡率（率比[RR] = 0.50，95%CI = 0.36-0.69，P < 0.001和RR = 0.67，95%CI = 0.45-0.998，P = 0.049）。两项研究的荟萃分析显示，阿司匹林的使用与HCC患者出血风险升高无关（HR = 0.71，95%CI = 0.41-1.23，P = 0.223）。结论：非甾体抗炎药的使用，尤其是阿司匹林，与肝癌发生的风险降低和肝癌人群的生存率提高有关。应进行高质量、设计良好的试验，以重新评估NSAID与HCC之间的关系。
Objective The roles of nonsteroidal anti-inflammatory drugs (NSAIDs) in the occurrence and prognosis of hepatocellular carcinoma (HCC) remain controversial. This analysis aimed to summarize the relationships between NSAIDs and HCC development. Methods Studies published prior to October 1, 2017, in the PubMed, Embase, Ovid, Web of Science, and Cochrane Library databases were systematically searched and analyzed. Results Eleven studies were included in this analysis. A meta-analysis of five studies revealed that aspirin use could significantly decrease the risk of HCC occurrence (hazards ratio [HR] = 0.64, 95% confidence interval [CI] = 0.45–0.91, P = 0.014). No significant difference was found for the use of NSAIDs (six studies) and non-aspirin NSAIDs (three studies) in HCC occurrence (HR = 0.74, 95%CI = 0.53–1.02, P = 0.064 and HR = 0.98, 95%CI = 0.87–1.12, P = 0.81, respectively). However, subgroup analysis of cohort studies demonstrated that NSAIDs significantly decreased the risk of HCC occurrence (HR = 0.58, 95%CI = 0.43–0.78, P < 0.001). HCC patients who received NSAIDs achieved better disease-free survival and overall survival compared with the non-NSAID users (HR = 0.79, 95%CI = 0.74–0.84, P<0.001 and HR = 0.60, 95%CI = 0.50–0.72, P<0.001, respectively). Additionally, a meta-analysis of two studies showed that aspirin treatment in HCC patients could significantly decrease the 2-year and 4-year mortalities (rate ratio [RR] = 0.50, 95%CI = 0.36–0.69, P < 0.001 and RR = 0.67, 95%CI = 0.45–0.998, P = 0.049, respectively). A meta-analysis of two studies showed that aspirin use was not associated with a higher risk of bleeding in HCC patients (HR = 0.71, 95%CI = 0.41–1.23, P = 0.223). Conclusion The use of NSAIDs, especially aspirin, is linked to a lower risk of HCC development and better survival in HCC populations. High-quality, well-designed trials should be conducted to reevaluate the relationships between NSAIDs and HCC.