Association of Daily Aspirin Therapy With Risk of Hepatocellular Carcinoma in Patients With Chronic Hepatitis B
Association of Daily Aspirin Therapy With Risk of Hepatocellular Carcinoma in Patients With Chronic Hepatitis B
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DOI：
10.1001/jamainternmed.2018.8342
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发表时间：
2019-05-01
影响因子：
39
通讯作者：
Wu, Chun-Ying
中科院分区：
文献类型：
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作者：
Lee, Teng-Yu;Hsu, Yao-Chun;Wu, Chun-Ying
重要性：抗病毒治疗不能消除慢性乙型肝炎患者发生肝细胞癌（HCC）的风险，也不适用于大多数乙型肝炎病毒（HBV）携带者。另一种降低HCC风险的有效方法有待开发。阿司匹林可以预防癌症的发展，但在hbv相关HCC患者中的临床证据仍然有限。目的探讨每日阿司匹林治疗与hbv相关HCC风险的关系。在这项台湾全国性队列研究中，我们从1997年1月1日至2012年12月31日筛选了204,507例慢性乙型肝炎患者。在排除混杂条件患者后，通过倾向评分，包括随访指标日期、基线特征和随访期间可能的化学预防药物使用情况，将2123例连续每日服用阿司匹林90天及以上的患者（治疗组）与8492例从未接受过抗血小板治疗的患者（未治疗组）以1:4随机匹配。数据分析时间为2018年8月1日至11月30日。暴露在研究期间每天服用阿司匹林。在将患者死亡率作为竞争风险事件进行调整后，对HCC发展的累积发病率和危险比（hr）进行分析。结果纳入分析的10615例患者中，男性7690例（72.4%）；平均（SD）年龄为58.8（11.8）岁。治疗组5年HCC累积发生率显著低于未治疗组(5.20%;95% CI, 4.11% ~ 6.29% vs 7.87%; 95% CI, 7.15% ~ 8.60%
IMPORTANCE Antiviral therapy cannot erase hepatocellular carcinoma (HCC) risk in patients with chronic hepatitis B, and it is not indicated for most hepatitis B virus (HBV) carriers. Another effective way of reducing HCC risk needs to be developed. Aspirin may prevent cancer development, but clinical evidence in patients with HBV-related HCC remains limited.OBJECTIVE To investigate the association of daily aspirin therapy with HBV-related HCC risk.DESIGN, SETTING, AND PARTICIPANTS In this Taiwan nationwide cohort study, we screened 204 507 patients with chronic hepatitis B for the period January 1, 1997, to December 31, 2012. After excluding patients with confounding conditions, 2123 patients who continuously received daily aspirin for 90 or more days (treated group) were randomly matched 1: 4 with 8492 patients who had never received antiplatelet therapy (untreated group) by means of propensity scores, consisting of the follow-up index date, baseline characteristics, and potentially chemopreventive drug use during follow-up. Data were analyzed from August 1 to November 30, 2018.EXPOSURES Daily aspirin therapy during the study period.MAIN OUTCOMES AND MEASURES Both cumulative incidence of and hazard ratios (HRs) for HCC development were analyzed after adjusting patient mortality as a competing risk event.RESULTS Of the 10 615 patients included in the analysis, 7690 (72.4%) were men; mean (SD) age was 58.8 (11.8) years. The cumulative incidence of HCC in the treated group was significantly lower than that in the untreated group in 5 years (5.20%; 95% CI, 4.11%-6.29% vs 7.87%; 95% CI, 7.15%-8.60%; P