Aspirin use after diagnosis but not prediagnosis improves established colorectal cancer survival: a meta-analysis
Aspirin use after diagnosis but not prediagnosis improves established colorectal cancer survival: a meta-analysis
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诊断后使用阿司匹林而不是诊断前使用阿司匹林可以改善已确定的结直肠癌生存率：一项荟萃分析。
DOI：
10.1136/gutjnl-2014-308260
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发表时间：
2015-09-01
期刊：
影响因子：
24.5
通讯作者：
Wu, Yihua
中科院分区：
文献类型：
--
作者：
Li, Peiwei;Wu, Han;Wu, Yihua
目的通过检索2014年5月前的PubMed、Embase和Cochrane数据库，系统评价阿司匹林对结直肠癌(CRC)患者诊断前后的生存效益。两名研究人员从纳入的研究中独立提取了基线特征和结果的数据。结果7篇关于诊断后阿司匹林治疗的研究和7篇关于诊断前阿司匹林使用的研究最终进入Meta分析。与诊断后使用阿司匹林相关的总体生存益处为0.84(95%可信区间为0.75至0.94)。在结肠癌(HR=0.78，95%CI为0.64~0.96)和直肠癌(HR=0.90，95%CI为0.83~0.98)中均可观察到上述作用。此外，诊断后使用阿司匹林的生存益处似乎仅限于前列腺素内过氧化物合成酶2(Ptgs2，也称为环氧合酶-2，COX-2)表达阳性(HR=0.65，95%CI为0.50~0.85)和PIK3CA肿瘤突变患者(HR=0.58，95%CI为0.37~0.90)。诊断后使用阿司匹林与结直肠癌特异性死亡率无关(HR=0.77，95%CI为0.52~1.14)。我们没有发现诊断前使用阿司匹林与结直肠癌总死亡率(HR=1.01，95%CI 0.96~1.06)或结直肠癌特定病死率(HR=0.93，95%CI 0.82~1.05)相关的证据。结论这些发现进一步表明，诊断后阿司匹林治疗可以改善结直肠癌总体生存率，特别是对于Ptgs2(COX-2)阳性和PIK3CA肿瘤突变的患者。
Objective The objective of this meta-analysis was to systematically assess the survival benefit of aspirin use before or after diagnosis for patients with colorectal cancer (CRC).Design Relevant studies were identified through searching PubMed, Embase and Cochrane databases before May 2014. Two investigators extracted data independently for baseline characteristics and outcomes from the included studies. Either a fixed-effects or a random-effects model was derived to composite the pooled HR for overall mortality and CRC-specific mortality of CRC.Results Seven studies on postdiagnosis aspirin therapy and seven studies on prediagnosis aspirin use were finally included in this meta-analysis. The overall survival benefit associated with postdiagnosis aspirin use represented an HR of 0.84 (95% CI 0.75 to 0.94). This effect was observed both in colon cancer (HR = 0.78, 95% CI 0.64 to 0.96) and in rectal cancer (HR = 0.90, 95% CI 0.83 to 0.98). Besides, the survival benefit of postdiagnosis aspirin use appeared to be confined to those patients with positive prostaglandin endoperoxide synthase 2 (PTGS2, also known as cyclooxygenase-2, COX-2) expression (HR = 0.65, 95% CI 0.50 to 0.85) and with mutated PIK3CA tumours (HR = 0.58, 95% CI 0.37 to 0.90). Aspirin use postdiagnosis was not associated with CRC-specific mortality (HR = 0.77, 95% CI 0.52 to 1.14). We observed no evidence of an association between prediagnosis aspirin use and CRC overall mortality (HR = 1.01, 95% CI 0.96 to 1.06) or CRC-specific mortality (HR = 0.93, 95% CI 0.82 to 1.05).Conclusions These findings provide further indication that postdiagnosis aspirin therapy improved CRC overall survival, especially for patients with positive PTGS2 (COX-2) expression and mutated PIK3CA tumours.