Association Between Aspirin Use and Gastric Adenocarcinoma: A Prospective Cohort Study.
Association Between Aspirin Use and Gastric Adenocarcinoma: A Prospective Cohort Study.
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DOI：
10.1158/1940-6207.capr-21-0413
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发表时间：
2022-04-01
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在非亚洲人群中，根据剂量和持续时间，研究阿司匹林使用与胃腺癌长期风险之间关系的前瞻性数据缺乏。我们在两项大型前瞻性美国队列研究中评估了阿司匹林使用与胃腺癌风险之间的关系，这两项研究是护士健康研究和健康专业人员随访研究。使用考克斯比例风险回归模型计算多变量调整后的风险比（HR）和95%置信区间（CI）。在159，116名参与者中，我们记录了316例胃腺癌病例（176例女性，140例男性），超过34年，涵盖450万人年。在女性中，与不规律使用阿司匹林相比，规律使用阿司匹林（每周至少2次或更多次）与胃腺癌风险降低显著相关（多变量HR 0.52，95% CI 0.37-0.73）。然而，定期服用阿司匹林与男性胃腺癌风险无关（多变量HR 1.08，95% CI 0.77-1.52）（性别P异质性= 0.003）。在女性中，随着阿司匹林使用时间的增加（趋势P <0.001）和每周超过5片（多变量HR，0.51; 95%CI 0.31-0.84），胃腺癌的风险降低更为明显。在女性中，长期规律服用阿司匹林与胃腺癌风险降低相关，但与男性无关。这种益处在使用至少10年后出现，并且在女性中使用更高剂量时最大化。阿司匹林使用与胃腺癌风险之间的性别异质性需要进一步研究。
Prospective data examining the association of aspirin use, according to dose and duration, with long-term risk of gastric adenocarcinoma in non-Asian cohorts are lacking. We evaluated the association between aspirin use and risk of gastric adenocarcinoma in two large prospective U.S. cohort studies, the Nurses’ Health Study and the Health Professionals Follow-up Study. Cox proportional hazards regression models were used to calculate multivariable adjusted hazard ratios (HRs) and 95% confidence intervals (CI). Among the 159,116 participants, we documented 316 gastric adenocarcinoma cases (176 women, 140 men) over 34 years encompassing 4.5 million person-years. Among women, regular aspirin use (at least 2 times or more per week) was significantly associated with lower risk of gastric adenocarcinoma (multivariable HR 0.52, 95% CI 0.37–0.73) compared with nonregular use. However, regular aspirin use was not associated with gastric adenocarcinoma risk among men (multivariable HR 1.08, 95% CI 0.77–1.52) (P-heterogeneity for sex = 0.003). Among women, the lower risk of gastric adenocarcinoma was more apparent with increasing duration of aspirin use (P for trend <.001) and more than 5 tablets per week (multivariable HR, 0.51; 95% CI 0.31–0.84). Regular, long-term aspirin use was associated with lower risk of gastric adenocarcinoma among women, but not men. The benefit appeared after at least 10 years of use and was maximized at higher doses among women. The heterogeneity by sex in the association of aspirin use with risk of gastric adenocarcinoma requires further investigation.