Association of aspirin and nonaspirin nonsteroidal anti-inflammatory drugs with cancer incidence and mortality
Association of aspirin and nonaspirin nonsteroidal anti-inflammatory drugs with cancer incidence and mortality
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DOI：
10.1093/jnci/djk200
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发表时间：
2007-06-06
影响因子：
10.3
通讯作者：
Cerhan, James R.
中科院分区：
文献类型：
--
作者：
Bardia, Aditya;Ebbert, Jon O.;Cerhan, James R.
背景：阿司匹林和非阿司匹林类非甾体抗炎药（NSAIDs）的癌症化学预防作用尚未完全确定，可能因吸烟史而异。我们在爱荷华州妇女健康研究中评估了阿司匹林和非阿司匹林非甾体抗炎药使用与癌症发病率和死亡率之间的关系，该研究是一项绝经后妇女的前瞻性队列研究，按吸烟史分层。方法1992年采用问卷自报阿司匹林和非阿司匹林类非甾体抗炎药使用情况。癌症发病率和死亡率通过与爱荷华州监测、流行病学和最终结果癌症登记和死亡证明的年度联系来确定。采用Cox比例风险模型估计多变量相对风险（RRs）和95%置信区间（Cis）。所有统计检验均为双侧检验。结果在平均10年的随访期间，在22507名妇女队列中观察到3487例癌症病例和3581例死亡。与不使用阿司匹林相比，阿司匹林的使用与总癌症发病率呈负相关（多变量校正RR = 0.84, 95% Cl = 0.77 ~ 0.90），曾经和从不使用阿司匹林的年龄校正发病率分别为147 / 10000人年和170 / 10000人年，与癌症死亡率呈负相关（多变量校正RR = 0.87, 95% Cl = 0.76 ~ 0.99），年龄校正死亡率分别为47 / 10000人年和52 / 10000人年。戒烟者与不吸烟者之间的负相关关系强于当前吸烟者，但无统计学意义（P= 0.28）。阿司匹林的使用也与冠心病死亡率呈负相关（多变量校正RR = 0.75, 95% Cl = 0.64 ~ 0.89），曾经和从未使用阿司匹林的年龄校正比率分别为每10000人年23人和30人，与全因死亡率（多变量校正RR = 0.82, 95% Cl = 0.76 ~ 0.89），年龄校正比率分别为每10000人年126和155人。非阿司匹林类非甾体抗炎药的使用与癌症发病率或死亡率、冠心病死亡率或全因死亡率无关。结论：阿司匹林的使用，而非非阿司匹林的非甾体抗炎药的使用，与较低的癌症发病率和死亡率相关，这在曾经吸烟和从不吸烟的人群中比现在吸烟的人群中更为明显。
Background The cancer chemopreventive benefits of aspirin and nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) are incompletely defined and may vary by smoking history. We evaluated associations between aspirin and nonaspirin NSAID use with cancer incidence and mortality stratified by smoking history in the Iowa Women's Health Study, a prospective cohort of postmenopausal women.Methods Aspirin and nonaspirin NSAID use was self-reported by questionnaire in 1992. Cancer incidence and mortality were ascertained by annual linkage to the Iowa Surveillance, Epidemiology, and End Results Cancer Registry and death certificates. Cox proportional hazards models were used to estimate multivariable relative risks (RRs) and 95% confidence intervals (Cis). All statistical tests were two-sided.Results During an average of 10 years of follow-up, 3487 incident cancer cases and 3581 deaths were observed in the cohort of 22507 women. Compared with nonuse, aspirin use was inversely associated with total cancer incidence (multivariable-adjusted RR = 0.84, 95% Cl = 0.77 to 0.90), with age-adjusted incidence rates of 147 and 170 per 10000 person-years for ever and never users, respectively, and was inversely associated with cancer mortality (multivariable-adjusted RR = 0.87, 95% Cl = 0.76 to 0.99), with age-adjusted rates of 47 and 52 per 10000 person-years. The inverse relationship was stronger among former and never smokers than current smokers, although not statistically significantly (P=.28). Aspirin use was also inversely associated with coronary heart disease mortality (multivariable-adjusted RR = 0.75, 95% Cl = 0.64 to 0.89), with age-adjusted rates of 23 and 30 per 10000 person-years for ever and never users, respectively, and with all-cause mortality (multivariable-adjusted RR = 0.82, 95% Cl = 0.76 to 0.89), with age-adjusted rates of 126 and 155 per 10000 person-years. Nonaspirin NSAID use was not associated with cancer incidence or mortality, coronary heart disease mortality, or all-cause mortality.Conclusions Aspirin use, but not nonaspirin NSAID use, was associated with lower risks of cancer incidence and mortality, which was more pronounced among former and never smokers than current smokers.