Aspirin, Statins, Non-aspirin NSAIDs, Metformin, and the Risk of Biliary Cancer: A Swedish Population-Based Cohort Study.
Aspirin, Statins, Non-aspirin NSAIDs, Metformin, and the Risk of Biliary Cancer: A Swedish Population-Based Cohort Study.
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DOI：
10.1158/1055-9965.epi-20-1322
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发表时间：
2022-04-01
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胆道癌包括肝内胆管癌（iCCA）、肝外胆管癌（eCCA）和胆囊癌（GBC），其化学预防存在争议。我们研究了低剂量阿司匹林、他汀类药物、NSAID和二甲双胍与BTC风险之间的关系。我们使用了一个基于人群的队列，其中包括570万18岁以上的人，他们没有个人癌症史（非黑色素瘤皮肤癌除外），在2005年7月1日至2012年12月31日期间接受了瑞典处方药登记处的至少一种常用处方药。使用年龄尺度多变量校正的考克斯模型计算风险比（HR）。2，160人开发了BTC。低剂量阿司匹林与BTC风险（HR 0.93; 95%CI：0.81-1.07）、iCCA（HR 1.21; 95%CI：0.93-1.57）、eCCA（HR 0.80; 95%CI：0.60-1.07）或GBC（HR 0.87; 95%CI：0.71-1.06）无关。他汀类药物与BTC（HR 0.66; 95%CI：0.56-0.78）、iCCA（HR 0.69; 95%CI：0.50-0.95）、eCCA（HR 0.54; 95%CI：0.38-0.76）和GBC（HR 0.72; 95%CI：0.57-0.91）风险较低相关。对于所有BTC亚型，低剂量阿司匹林和他汀类药物联合使用与单独使用他汀类药物相比风险降低无关。NSAIDs与BTC及其亚型的高风险相关。二甲双胍与BTC风险（HR 0.98; 95%CI：0.82-1.18）、iCCA（HR 1.06; 95%CI：0.77-1.48）、eCCA（HR 1.15; 95%CI：0.82-1.61）或GBC（HR 0.84; 95%CI：0.63-1.11）无关。他汀类药物与BTC及其亚型的风险降低相关。单独使用低剂量阿司匹林与风险降低无关，两者联合使用与他汀类药物以外的风险进一步降低无关。他汀类药物与BTC及其亚型的风险降低最一致。
Chemoprevention for biliary tract cancers (BTCs), which comprise intrahepatic cholangiocarcinoma (iCCA), extrahepatic cholangiocarcinoma (eCCA) and gallbladder cancer (GBC), is controversial. We examined associations between low-dose aspirin, statins, NSAIDs, and metformin with BTC risk. We used a population-based cohort of 5.7 million persons over age 18 without personal history of cancer (except non-melanoma skin cancer), receiving at least one commonly-prescribed drug between July 1, 2005, and December 31, 2012, from the Swedish Prescribed Drug Registry. Hazard ratios (HRs) were calculated using age-scaled multivariable-adjusted Cox models. 2,160 individuals developed BTC. Low-dose aspirin was not associated with BTC risk (HR 0.93; 95%CI:0.81–1.07), iCCA (HR 1.21; 95%CI:0.93–1.57), eCCA (HR 0.80; 95%CI:0.60–1.07) or GBC (HR 0.87; 95%CI:0.71–1.06). Statins were associated with lower risk of BTC (HR 0.66; 95%CI:0.56–0.78), iCCA (HR 0.69; 95%CI:0.50–0.95), eCCA (HR 0.54; 95%CI:0.38–0.76), and GBC (HR 0.72; 95%CI:0.57–0.91). For all BTC subtypes, combined low-dose aspirin and statins were not associated with lower risk than statins alone. NSAIDs were associated with higher risk of BTC and its subtypes. Metformin was not associated with BTC risk (HR 0.98; 95%CI:0.82–1.18), iCCA (HR 1.06; 95%CI:0.77–1.48), eCCA (HR 1.15; 95%CI:0.82–1.61) or GBC (HR 0.84; 95%CI:0.63–1.11). Statins were associated with a decreased risk of BTC and its subtypes. Low-dose aspirin alone was not associated with a decreased risk and use of both was not associated with further decrease in risk beyond statins alone. Statins were most consistently associated with a decreased risk of BTC and its subtypes.