Association of Daily Aspirin Therapy With Risk of Hepatocellular Carcinoma in Patients With Chronic Hepatitis B

被引:119
作者
Lee, Teng-Yu [2 ,3 ]
Hsu, Yao-Chun [4 ,5 ,6 ,7 ]
Tseng, Hsiao-Ching [1 ,8 ]
Yu, Shi-Hang [2 ]
Lin, Jaw-Town [5 ,9 ]
Wu, Ming-Shiang [10 ]
Wu, Chun-Ying [1 ,8 ,11 ,12 ,13 ,14 ]
机构
[1] Taipei Vet Gen Hosp, Div Translat Med, Dept Med Res, 322,Sect 2,Shipai Rd, Taipei 11217, Taiwan
[2] Taichung Vet Gen Hosp, Div Gastroenterol & Hepatol, Taichung, Taiwan
[3] Chung Shan Med Univ, Dept Med, Taichung, Taiwan
[4] Fu Jen Catholic Univ Hosp, Div Gastroenterol & Hepatol, New Taipei, Taiwan
[5] Fu Jen Catholic Univ, Sch Med, Coll Med, New Taipei, Taiwan
[6] E Da Hosp, Div Gastroenterol & Hepatol, Kaohsiung, Taiwan
[7] China Med Univ, Grad Inst Clin Med, Taichung, Taiwan
[8] Taipei Vet Gen Hosp, Excellence Canc Res Ctr, Dept Med Res, Taipei, Taiwan
[9] Natl Hlth Res Inst, Inst Populat Hlth Sci, Miaoli, Taiwan
[10] Natl Taiwan Univ Hosp, Dept Internal Med, Taipei, Taiwan
[11] Natl Yang Ming Univ, Fac Med, Sch Med, Taipei, Taiwan
[12] China Med Univ, Coll Publ Hlth, Taichung, Taiwan
[13] China Med Univ, Grad Inst Clin Med Sci, Taichung, Taiwan
[14] Natl Hlth Res Inst, Natl Inst Canc Res, Miaoli, Taiwan
关键词
CLINICAL-PRACTICE GUIDELINES; INSURANCE RESEARCH DATABASE; ANTIINFLAMMATORY DRUG-USE; CHRONIC LIVER-DISEASE; NUCLEOS(T)IDE ANALOG; ANTIPLATELET THERAPY; PRIMARY PREVENTION; RECURRENCE; APOPTOSIS; VALIDATION;
D O I
10.1001/jamainternmed.2018.8342
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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<.001). In the multivariable regression analysis, aspirin therapy was independently associated with a reduced HCC risk (HR, 0.71; 95% CI, 0.58-0.86; P<.001). Sensitivity subgroup analyses also verified this association (all HRs<1.0). In addition, older age (HR, 1.01 per year; 95% CI, 1.00-1.02), male sex (HR, 1.75; 95% CI, 1.43-2.14), and cirrhosis (HR, 2.89; 95% CI, 2.45-3.40) were independently associated with an increased HCC risk, but nucleos(t) ide analogue (HR, 0.54; 95% CI, 0.41-0.71) or statin (HR, 0.62; 95% CI, 0.42-0.90) use was correlated with a decreased HCC risk. CONCLUSIONS AND RELEVANCE Daily aspirin therapymay be associated with a reduced risk of HBV-related HCC.
引用
收藏
页码:633 / 640
页数:8
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