Regular aspirin use and risk of multiple myeloma: a prospective analysis in the health professionals follow-up study and nurses' health study.
Regular aspirin use and risk of multiple myeloma: a prospective analysis in the health professionals follow-up study and nurses' health study.
复制标题
DOI：
10.1158/1940-6207.capr-13-0224
复制
发表时间：
2014-01
期刊：
影响因子：
--
通讯作者：
Colditz GA
中科院分区：
文献类型：
--
作者：
Birmann BM;Giovannucci EL;Rosner BA;Colditz GA
多发性骨髓瘤（MM）是一种病因不明且无预防策略的致死性恶性肿瘤。阿司匹林可抑制核因子（NF）-κB、环氧合酶（考克斯）-2或其靶点介导的几种通路，这些通路在MM发病机制中具有重要作用。我们在健康专业人员随访研究和护士健康研究队列中进行了前瞻性分析，以检查定期使用阿司匹林是否会影响MM风险。我们使用每两年更新一次的数据来描述从基线到癌症诊断、死亡或2008年的阿司匹林使用情况。我们在暴露分类中应用了4年的滞后，以减少临床前MM对阿司匹林使用习惯的影响。我们从多变量比例风险模型中获得风险比（HR）和95%置信区间（CI），以评估阿司匹林使用与MM风险的相关性。我们测试了增加使用量和持续时间的趋势。在2，395，458人年中，我们确认了328例MM诊断事件，其中265例具有典型阿司匹林剂量和频率的前瞻性信息。累积平均≥5片成人规格（325 mg）片剂/周的受试者的MM风险比非使用者低39%（HR，95% CI：0.61，0.39-0.94;片剂/周，P趋势=0.06）。连续定期使用阿司匹林≥11年的患者MM风险也较低（HR，95% CI：0.63，0.41-0.95;持续时间，P趋势=0.17）。这种关联在男性中比女性中更强，可能反映了阿司匹林使用模式的性别差异。这项关于阿司匹林使用和MM的前瞻性研究支持阿司匹林抑制的病因作用（即，NF-κB-或考克斯-2-介导的）途径。阿司匹林用于MM化学预防的效用值得进一步评价。
Multiple myeloma (MM) is a lethal malignancy with an unknown etiology and no prevention strategy. Aspirin inhibits several pathways mediated by nuclear factor (NF)-κB, cyclooxygenase (COX)-2, or their targets that are important in MM pathogenesis. We conducted prospective analyses in the Health Professionals Follow-up Study and Nurses’ Health Study cohorts to examine whether regular aspirin use influences MM risk. We used biennially updated data to characterize aspirin use from baseline through a cancer diagnosis, death, or 2008. We applied a four-year lag in exposure classification to diminish the influence of preclinical MM on aspirin use habits. We obtained hazard ratios (HR) and 95% confidence intervals (CI) from multivariable proportional hazard models to assess the association of aspirin use with MM risk. We tested for trend across increasing quantity and duration of use. During 2,395,458 person-years, we confirmed 328 incident MM diagnoses, including 265 with prospective information on typical aspirin dose and frequency. Participants with a cumulative average of ≥5 adult strength (325-mg) tablets/week had a 39% lower MM risk than non-users (HR, 95% CI: 0.61, 0.39–0.94; tablets/week, P-trend=0.06). Persons with ≥11 years of continuous regular aspirin use also had a lower MM risk (HR, 95% CI: 0.63, 0.41–0.95; duration, P-trend=0.17). The associations appeared stronger in men than in women, possibly reflecting gender differences in aspirin use patterns. This prospective study of aspirin use and MM supports an etiologic role for aspirin-inhibited (i.e., NF-κB- or COX-2-mediated) pathways. The utility of aspirin for MM chemoprevention warrants further evaluation.