Use of nonsteroidal anti-inflammatory drugs and incidence of colorectal cancer -: A population-based study
Use of nonsteroidal anti-inflammatory drugs and incidence of colorectal cancer -: A population-based study
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DOI：
10.1001/archinte.159.2.161
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发表时间：
1999-01-25
影响因子：
--
通讯作者：
Griffin, MR
中科院分区：
文献类型：
--
作者：
Smalley, W;Ray, WA;Griffin, MR
背景资料：以前的观察性研究提供的关于特定非甾体抗炎药（NSAID）和不同使用模式的影响的信息有限目的：确定如何使用模式（持续时间和剂量）对结直肠癌的发病率。非甾体类抗炎药（持续时间、剂量和具体药物）对结直肠癌发病率的影响。设计：基于人群的回顾性队列研究。设置：1985- 1992年田纳西州医疗补助计划（n = 104217）年龄≥ 65岁，至少入组5年。主要结果指标：组织学确诊的结肠直肠癌事件。结果：在过去5年中至少48个月使用非阿司匹林非甾体抗炎药的患者的相对风险（RR）为0.49（95%置信区间[CI]，0.24-1.00），与未使用NSAID的患者相比，在累积使用超过12个月的患者中，过去一年使用NSAID的患者（近期使用者）的RR为0.61（95% CI，0.48-0.77），而近期未使用的患者的RR为0.76（95% CI，0.50-1.15）。没有特定的NSAID提供独特的保护作用，低剂量的NSAID似乎至少与高剂量一样有效。右侧病变的保护作用最为明显。最近使用者累积使用超过12个月的RR为0.81（95%CI，0.49-1.32）直肠癌，0.77（95% CI，0.55-1.08）左侧结肠癌，0.48（95%CI，0.34-0.68）右侧结肠癌。结论：在老年人群中，长期使用非阿司匹林类非甾体抗炎药几乎使结肠癌的风险减半。这项研究与先前的研究一致，这些研究表明，NSAID的使用持续时间而不是每日剂量是化学预防的重要因素。我们的数据还表明，大多数非甾体抗炎药都具有这种保护作用，而不仅仅限于少数此类药物。
Background: Previous observational studies have provided limited information on the effect of specific nonsteroidal anti-inflammatory drugs (NSAIDs) and different patterns of use (duration and dose) on the incidence of colorectal cancer.Objective: To determine how patterns of use (duration, dose, and specific drug) of NSAIDs affect incidence of colorectal cancer.Design: Population-based retrospective cohort study.Setting: Tennessee Medicaid Program, 1985-1992.Subjects: Enrollees (n = 104 217) aged 65 years or older with at least 5 years of enrollment.Main Outcome Measures: Incident histologically confirmed colorectal cancer.Results: Users of nonaspirin NSAIDs for at least 48 months of the previous 5 years had a relative risk (RR) of 0.49 (95% confidence interval [CI], 0.24-1.00) for colon cancer when compared with those with no use of NSAIDs. Among those with more than 12 months of cumulative use, those using NSAIDs in the past year (recent users) had an RR of 0.61 (95% CI, 0.48-0.77), whereas those with no recent use had an RR of 0.76 (95% CI, 0.50-1.15). No specific NSAID offered a unique protective effect and low doses of NSAIDs appeared to be at least as effective as higher doses. Protection was most pronounced for right-sided lesions. The RR among recent users with more than 12 months of cumulative use was 0.81 (95% CI, 0.49-1.32) for rectal cancer, 0.77 (95% CI, 0.55-1.08) for left-sided colon cancer, and 0.48 (95% CI, 0.34-0.68) for right-sided colon cancer.Conclusions: In this elderly population, long-term use of nonaspirin NSAIDs nearly halved the risk of colon cancer. This study was consistent with previous studies that suggest that duration of use but not daily dose of NSAIDs is an important factor for chemoprevention. Our data also suggest that the protective effect is shared by most NSAIDs, and not confined to a small number of these drugs.