Aspirin and the risk of colorectal and other digestive tract cancers: an updated meta-analysis through 2019 (Retracted Article)
Aspirin and the risk of colorectal and other digestive tract cancers: an updated meta-analysis through 2019 (Retracted Article)
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DOI：
10.1016/j.annonc.2020.02.012
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发表时间：
2020-05-01
影响因子：
50.5
通讯作者：
La Vecchia, C.
中科院分区：
文献类型：
--
作者：
Bosetti, C.;Santucci, C.;La Vecchia, C.
背景：阿司匹林与降低结直肠癌的风险有关，也可能与降低其他一些消化道癌症的风险有关。风险降低的量化以及阿司匹林用于预防结直肠癌和其他消化道癌症的最佳剂量和持续时间仍不清楚。方法：为了提供这种关联的最新量化，我们对截至2019年3月发表的所有关于阿司匹林和消化道部位癌症的观察性研究进行了系统回顾和荟萃分析。我们使用随机效应模型估计了定期服用阿司匹林与不服用阿司匹林的总相对风险（RR），并且，只要有数据，我们就调查了剂量和持续时间-风险关系。结果:定期服用阿司匹林与降低结直肠癌的风险(RR = 0.73, 95%可信区间(CI) = 0.69 - -0.78, 45研究],鳞状细胞食道癌(RR = 0.67, 95% CI -0.79 = 0.57, 13个研究),食管腺癌和胃贲门(RR = 0.61, 95% CI -0.77 = 0.49, 10个研究),胃癌(RR = 0.64, 95% CI -0.82 = 0.51, 14个研究),hepato-biliary呼吸道癌症(RR = 0.62, 95% CI -0.86 = 0.44,五个研究),和胰腺癌(RR = 0.78,95% CI = 0.68-0.89, 15项研究)，但头颈癌没有（RR = 0.94, 95% CI = 0.76-1.16, 10项研究）。在病例对照研究中，这种关联比在队列和巢式病例对照研究中更强，并且具有研究间异质性的特点。风险估计在性别、地理区域和其他选定的协变量之间是一致的。对于结直肠癌，阿司匹林剂量在75至100毫克/天之间可使风险降低10%，剂量为325毫克/天可使风险降低35%。除头颈癌外，所有肿瘤的发病时间与阿司匹林的使用呈负相关。结论：本综合荟萃分析支持并进一步量化了定期服用阿司匹林与结直肠癌和其他消化道癌症（包括一些罕见的癌症）风险之间的负相关关系。阿司匹林的有利作用随着使用时间的延长而增加，对于结直肠癌，则随着剂量的增加而增加。
Background: Aspirin has been associated with a reduced risk of colorectal cancer, and possibly of a few other digestive tract cancers. The quantification of risk reduction and the optimal dose and duration of aspirin use for the prevention of colorectal and other digestive tract cancers remains unclear.Methods: To provide an up-to-date quantification of this association, we conducted a systematic review and meta-analysis of all observational studies on aspirin and cancers of the digestive tract sites published through March 2019. We estimated the pooled relative risk (RR) of cancer for regular aspirin use versus non-use using random-effects models, and, whenever data were available, we investigated the dose- and duration-risk relations.Results: Regular aspirin use is associated with a reduced risk of colorectal cancer [RR = 0.73, 95% confidence interval (CI) = 0.69-0.78, 45 studies], squamous-cell esophageal cancer (RR = 0.67, 95% CI = 0.57-0.79, 13 studies), adenocarcinoma of the esophagus and gastric cardia (RR = 0.61, 95% CI = 0.49-0.77, 10 studies), stomach cancer (RR = 0.64, 95% CI = 0.51-0.82, 14 studies), hepato-biliary tract cancer (RR = 0.62, 95% CI = 0.44-0.86, five studies), and pancreatic cancer (RR = 0.78, 95% CI = 0.68-0.89, 15 studies), but not of head and neck cancer (RR = 0.94, 95% CI = 0.76-1.16, 10 studies). The associations are somewhat stronger in case-control than in cohort and nested case-control studies and are characterized by some between-study heterogeneity. Risk estimates are consistent across sex, geographical areas, and other selected covariates. For colorectal cancer, an aspirin dose between 75 and 100 mg/day conveys a risk reduction of 10%, and a dose of 325 mg/day of 35%. For all neoplasms, except head and neck cancer, inverse duration-risk relations with aspirin use are found.Conclusion: The present comprehensive meta-analysis supports and further quantifies the inverse association between regular aspirin use and the risk of colorectal and other digestive tract cancers, including some rare ones. The favorable effect of aspirin increases with longer duration of use, and, for colorectal cancer, with increasing dose.