Aspirin use and survival after diagnosis of colorectal cancer.
Aspirin use and survival after diagnosis of colorectal cancer.
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DOI：
10.1001/jama.2009.1112
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发表时间：
2009-08-12
影响因子：
120.7
通讯作者：
Fuchs, Charles S.
中科院分区：
文献类型：
--
作者：
Chan, Andrew T.;Ogino, Shuji;Fuchs, Charles S.
阿司匹林在随机试验中降低结直肠癌的风险，在动物模型中抑制肿瘤的生长和转移。然而，阿司匹林对结直肠癌诊断后生存的影响尚不清楚。探讨结直肠癌诊断后服用阿司匹林对结直肠癌特异性和总生存率的影响。对1279名诊断为I、II或III期结直肠癌的男性和女性进行前瞻性队列研究。参与者于1980年和1986年在诊断前被纳入两个全国卫生专业队列，并随访至2008年6月1日。结直肠癌特异性死亡率和总体死亡率。在中位11.8年的随访后，549名结直肠癌诊断后经常使用阿司匹林的参与者中有193人死亡（35%）和81人结直肠癌特异性死亡（15%），而730名未使用阿司匹林的参与者中有287人死亡（39%）和141人结直肠癌特异性死亡（19%）。与非服用者相比，诊断后定期服用阿司匹林的参与者的结直肠癌特异性死亡率的多变量风险比（HR）为0.71(95%可信区间[CI]， 0.53-0.95)，总死亡率为0.79 （95% CI, 0.65-0.97）。在诊断前未使用阿司匹林的719名参与者中，诊断后开始使用阿司匹林与结直肠癌特异性死亡率的多变量风险比为0.53 （95% CI, 0.33-0.86）。在459名可进行免疫组化评估的结直肠癌患者中，阿司匹林的效果根据环氧化酶2 （COX-2）的表达有显著差异（相互作用P = 0.04）。在原发肿瘤COX-2过表达的患者中，诊断后定期服用阿司匹林与较低的结直肠癌特异性死亡风险相关（多变量风险比，0.39;95% CI, 0.20-0.76），而原发肿瘤COX-2表达弱或缺失的患者服用阿司匹林与较低的风险无关（多变量风险比，1.22;95% CI, 0.36-4.18）。结直肠癌诊断后定期服用阿司匹林可降低结直肠癌特异性死亡率和总体死亡率，特别是在肿瘤过表达COX-2的个体中。
Aspirin reduces risk of colorectal neoplasia in randomized trials and inhibits tumor growth and metastases in animal models. However, the influence of aspirin on survival after diagnosis of colorectal cancer is unknown. To examine the association between aspirin use after colorectal cancer diagnosis on colorectal cancer–specific and overall survival. Prospective cohort study of 1279 men and women diagnosed with stage I, II, or III colorectal cancer. Participants were enrolled in 2 nationwide health professional cohorts in 1980 and 1986 prior to diagnosis and followed up through June 1, 2008. Colorectal cancer–specific and overall mortality. After a median follow-up of 11.8 years, there were 193 total deaths (35%) and 81 colorectal cancer–specific deaths (15%) among 549 participants who regularly used aspirin after colorectal cancer diagnosis, compared with 287 total deaths (39%) and 141 colorectal cancer–specific deaths (19%) among 730 participants who did not use aspirin. Compared with nonusers, participants who regularly used aspirin after diagnosis experienced a multivariate hazard ratio (HR) for colorectal cancer–specific mortality of 0.71 (95% confidence interval [CI], 0.53-0.95) and for overall mortality of 0.79 (95% CI, 0.65-0.97). Among 719 participants who did not use aspirin before diagnosis, aspirin use initiated after diagnosis was associated with a multivariate HR for colorectal cancer–specific mortality of 0.53 (95% CI, 0.33-0.86). Among 459 participants with colorectal cancers that were accessible for immunohistochemical assessment, the effect of aspirin differed significantly according to cyclooxygenase 2 (COX-2) expression (P for interaction = .04). Regular aspirin use after diagnosis was associated with a lower risk of colorectal cancer–specific mortality among participants in whom primary tumors overexpressed COX-2 (multivariate HR, 0.39; 95% CI, 0.20-0.76), whereas aspirin use was not associated with lower risk among those with primary tumors with weak or absent expression (multivariate HR, 1.22; 95% CI, 0.36-4.18). Regular aspirin use after the diagnosis of colorectal cancer is associated with lower risk of colorectal cancer–specific and overall mortality, especially among individuals with tumors that overexpress COX-2.
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影响因子：
158.5
作者：
GIOVANNUCCI, E;EGAN, KM;SPEIZER, FE
通讯作者：
SPEIZER, FE
影响因子：
158.5
作者：
Bertagnolli, Monica M.;Eagle, Craig J.;Hawk, Ernest T.
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Hawk, Ernest T.
影响因子：
11.5
作者：
Fux, R;Schwab, M;Fritz, P
通讯作者：
Fritz, P
影响因子：
56.9
作者：
KOPP, E;GHOSH, S
通讯作者：
GHOSH, S
影响因子：
39.2
作者：
Dube, Catherine;Rostom, Alaa;Moher, David
通讯作者：
Moher, David