Can We Select Patients for Colorectal Cancer Prevention with Aspirin?
Can We Select Patients for Colorectal Cancer Prevention with Aspirin?
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DOI：
10.2174/1381612821666150915111000
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发表时间：
2015-01-01
影响因子：
3.1
通讯作者：
Arber, Nadir
中科院分区：
文献类型：
--
作者：
Kraus, Sarah;Sion, Daniel;Arber, Nadir
阿司匹林在预防心血管疾病方面已被广泛研究。它是支持其用于结直肠癌（CRC）化学预防的最强有力的累积证据之一。流行病学、临床和观察性研究表明，阿司匹林和非甾体抗炎药（NSAIDs），包括COX-2抑制剂，可以预防结直肠癌并显著降低其发病率。此外，对结直肠息肉复发和遗传性CRC综合征患者的前瞻性随机对照试验表明，阿司匹林可使现有结直肠腺瘤消退，防止新息肉的形成。然而，最低有效剂量、治疗时间、目标人群和对生存的影响尚不完全清楚。虽然不常见的严重副作用，特别是胃肠道和脑出血确实会发生，但必须仔细选择可能从阿司匹林使用中获益最多的个体，以最大化他们的风险/收益比。在精准医疗时代，遗传信息、血液和/或尿液生物标记物可能有助于根据阿司匹林的使用量身定制化学预防治疗策略，同时限制不良毒性作用。目前的综述将涵盖阿司匹林在预防结直肠腺瘤和结直肠癌中的应用、化学预防的潜在标志物和患者分层。
Aspirin has been extensively investigated in the context of the prevention of cardiovascular disease. It has one of the strongest cumulative evidence supporting its use in colorectal cancer (CRC) chemoprevention. Epidemiological, clinical, and observational studies have demonstrated that aspirin and non-steroidal antiinflammatory drugs (NSAIDs), including COX-2 inhibitors, can protect against CRC and significantly reduce its incidence. Moreover, prospective randomized controlled trials of colorectal polyp recurrence and in patients with hereditary CRC syndromes have shown that aspirin can produce regression of existing colorectal adenomas and prevent the formation of new polyps. However, the lowest effective doses, treatment duration, target populations, and the effects on survival are not entirely clear. Although not common serious side effects and in particular gastrointestinal and intracerebral hemorrhage do occur, better selection of individuals who might benefit the most from aspirin use must be carefully performed in order to maximize their risk/benefit ratio. In the era of precision medicine, genetic information, blood and/or urinary biomarkers, could potentially help in tailoring chemopreventive therapeutic strategies, based on aspirin use, while limiting adverse toxic effects. The current review will cover the use of aspirin for the prevention of colorectal adenomas and CRC, potential markers for chemoprevention, and patient stratification.