The use of aspirin for primary prevention of colorectal cancer: A systematic review prepared for the US Preventive Services Task Force
The use of aspirin for primary prevention of colorectal cancer: A systematic review prepared for the US Preventive Services Task Force
复制标题
DOI：
10.7326/0003-4819-146-5-200703060-00009
复制
发表时间：
2007-03-06
影响因子：
39.2
通讯作者：
Moher, David
中科院分区：
文献类型：
--
作者：
Dube, Catherine;Rostom, Alaa;Moher, David
背景：阿司匹林用于预防结直肠癌存在争议。
目的：检验阿司匹林化学预防的益处和危害。
数据来源：1966年至2006年12月的MEDLINE；1980年至2005年4月的EMBASE；CENTRAL（科克伦协作网临床试验注册库）；科克伦系统评价数据库。
研究选择：两名独立评审员进行多级筛选，以确定阿司匹林化学预防的随机对照试验（RCT）、病例对照研究和队列研究。对于危害，则寻找系统评价。
数据提取：数据一式两份提取、核对，并评估质量。
数据综合：在RCT中，规律使用阿司匹林降低了结肠腺瘤的发病率（相对危险度[RR]，0.82[95%置信区间，0.7 - 0.95]），在病例对照研究中（RR，0.87[置信区间，0.77 - 0.98]）以及队列研究中（RR，0.72[置信区间，0.61 - 0.85]）也是如此。在队列研究中，规律使用阿司匹林使结直肠癌发病率的RR降低22%。两项低剂量阿司匹林的RCT未能显示出保护作用。结直肠癌死亡率的数据有限。当阿司匹林高剂量使用且使用时间超过10年时，化学预防的益处更为明显。阿司匹林的使用与胃肠道并发症发病率的剂量相关性增加有关。
局限性：在阿司匹林规律使用的定义、剂量和使用持续时间方面存在重要的临床和方法学异质性，这需要仔细分组进行分析。
结论：阿司匹林似乎能有效降低结肠腺瘤和结直肠癌的发病率，尤其是高剂量使用超过10年时。然而，这种做法可能带来的危害需要仔细考虑。需要进一步评估化学预防与筛查策略相比以及与筛查策略联合使用的成本效益。
Background: Aspirin for prevention of colorectal cancer is controversial.Purpose: To examine the benefits and harms of aspirin chemoprevention.Data Sources: MEDLINE, 1966 to December 2006; EMBASE, 1980 to April 2005; CENTRAL, Cochrane Collaboration's registry of clinical trials; Cochrane Database of Systematic Reviews.Study Selection: Two independent reviewers conducted multilevel screening to identify randomized, controlled trials (RCTs), case-control studies, and cohort studies of aspirin chemoprophylaxis. For harms, systematic reviews were sought.Data Extraction: In duplicate, data were abstracted and checked and quality was assessed.Data Synthesis: Regular use of aspirin reduced the incidence of colonic adenomas in RCTs (relative risk [RR], 0.82 [95% CI, 0.7 to 0.95]), case-control studies (RR, 0.87 [CI, 0.77 to 0.98]), and cohort studies (RR, 0.72 [CI, 0.61 to 0.85]). In cohort studies, regular use of aspirin was associated with RR reductions of 22% for incidence of colorectal cancer. Two RCTs of low-dose aspirin failed to show a protective effect. Data for colorectal cancer mortality were limited. Benefits from chemoprevention were more evident when aspirin was used at a high dose and for periods longer than 10 years. Aspirin use was associated with a dose-related increase in incidence of gastrointestinal complications.Limitations: Important clinical and methodological heterogeneity in the definitions of regular use, dose, and duration of use of aspirin necessitated careful grouping for analysis.Conclusions: Aspirin appears to be effective at reducing the incidence of colonic adenoma and colorectal cancer, especially if used in high doses for more than 10 years. However, the possible harms of such a practice require careful consideration. Further evaluation of the cost-effectiveness of chemoprevention compared with, and in combination with, a screening strategy is required.