Prediagnostic non-steroidal anti-inflammatory drug use and survival after diagnosis of colorectal cancer.
Prediagnostic non-steroidal anti-inflammatory drug use and survival after diagnosis of colorectal cancer.
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DOI：
10.1136/gut.2010.221143
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发表时间：
2011-04
期刊：
影响因子：
24.5
通讯作者：
Ulrich CM
中科院分区：
文献类型：
--
作者：
Coghill AE;Newcomb PA;Campbell PT;Burnett-Hartman AN;Adams SV;Poole EM;Potter JD;Ulrich CM
非甾体抗炎药（NSAID）的使用降低了既往结直肠肿瘤患者结直肠癌和腺瘤复发的发生率。然而，很少有研究调查非甾体抗炎药使用与结直肠癌特异性生存率之间的关系。因此，我们在西雅图结肠癌家庭登记处（Seattle Colon CFR）的病例中研究了诊断前使用非甾体抗炎药与结直肠癌特异性生存率的关系。这是一项随访研究包括了来自西雅图结肠CFR的结直肠癌病例。病例年龄在20-74岁之间，诊断时间为1997-2002年，并通过普吉特海湾SEER人口登记来确定。通过访谈者管理的问卷调查收集了非甾体抗炎药使用史的详细信息，包括类型、近期和持续时间。通过与国家死亡指数（NDI）的联系，完成了对死亡率的随访。主要结局指标为诊断后结直肠癌死亡。采用Cox比例风险回归研究诊断前使用非甾体抗炎药与病例中结直肠癌特异性死亡率之间的关系。与从未使用相比，在结直肠癌诊断前使用非甾体抗炎药与诊断后结直肠癌死亡率降低约20%相关（HR: 0.79; 95% CI 0.65-0.97）。这种关系似乎是持续时间依赖性的，诊断前报告的使用时间越长，结直肠癌死亡率越低。在诊断为近端疾病的病例中观察到最显著的死亡率降低（HR: 0.55; 95% CI 0.37-0.82），而在诊断为远端或直肠疾病的病例中，我们观察到诊断前使用非甾体抗炎药与结直肠癌特异性死亡率之间没有关联。我们的研究结果表明，诊断前定期使用非甾体抗炎药与提高结直肠癌生存率有关，特别是在诊断为近端疾病的病例和长期使用非甾体抗炎药的病例中。
Nonsteroidal anti-inflammatory drug (NSAID) use decreases both the incidence of colorectal cancer and recurrence of adenomas among patients with prior colorectal neoplasia. However, few studies have investigated the association between NSAID use and colorectal cancer-specific survival. We therefore examined the role of pre-diagnostic NSAID use in relation to colorectal cancer-specific survival among cases from the Seattle Colon Cancer Family Registry (Seattle Colon CFR). This was a follow up study that included incident cases of colorectal cancer from the Seattle Colon CFR. Cases were ages 20–74, diagnosed from 1997–2002, and were identified using the population-based Puget Sound SEER registry. Detailed information on history of NSAID use, including type, recency, and duration, was collected through an interviewer-administered questionnaire. Follow-up for mortality was completed through linkages to the National Death Index (NDI). The main outcome measure was death due to colorectal cancer after diagnosis. Cox proportional hazards regression was used to investigate the relationship between pre-diagnostic NSAID use and colorectal cancer-specific mortality among cases. NSAID use prior to colorectal cancer diagnosis was associated with an approximately 20% lower rate of colorectal cancer mortality after diagnosis compared to never use (HR: 0.79; 95% CI 0.65–0.97). This relationship appeared to be duration-dependent, with longer reported use prior to diagnosis associated with lower rates of colorectal cancer mortality among cases. The most pronounced reductions in mortality were observed among cases diagnosed with proximal disease (HR: 0.55; 95% CI 0.37–0.82), whereas we observed no association between NSAID use prior to diagnosis and colorectal cancer-specific mortality among cases diagnosed with distal or rectal disease. Our findings suggest that regular use of NSAIDs prior to diagnosis is associated with improved colorectal cancer survival, particularly among cases diagnosed with proximal disease and in longer-term NSAID users.
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