每日阿司匹林治疗与肝细胞癌之间的关联（根据代谢） 慢性

StephenW

每日阿司匹林治疗与肝细胞癌之间的关联（根据代谢）
慢性乙型肝炎患者的风险因素负担
AASLD 2021 十一月 12-15

Cheol-Hyung Lee1,2, Yun Bin Lee1, Hyemi Moon3, Jong-Won Chung4, Eun Ju Cho1, Jeong-Hoon Lee1, Su Jong Yu1, Yoon Jun Kim1, Juneyoung Lee3 and Jung-Hwan Yoon1, (1) 内务部首尔国立大学医学院医学与肝脏研究所，首尔，韩国，（2）韩国城南武装部队医疗司令部，（3）高丽大学医学院生物统计系，（4）系韩国首尔成均馆大学医学院三星医学中心神经内科

背景：几项研究提供的证据支持阿司匹林对慢性乙型肝炎 (CHB) 患者的肝细胞癌 (HCC) 的化学预防作用。最近，我们证明每天使用阿司匹林与非肝硬化 CHB 患者的 HCC 风险降低相关，但与肝硬化患者无关。为了确定每日阿司匹林治疗的更好候选者，我们根据代谢危险因素负荷调查了阿司匹林使用与 HCC 风险的关联，代谢危险因素负荷是非肝硬化 CHB 中 HCC 的独立危险因素。

方法：我们使用韩国国民健康保险服务数据库收集了 282,611 名成人非肝硬化慢性乙肝患者的代谢危险因素基线数据，包括肥胖、高血压、高胆固醇血症和糖尿病。根据代谢风险因素的数量对研究患者进行分层，然后生成倾向评分匹配的队列以平衡阿司匹林使用者和非使用者之间的基线特征。分析了 HCC 的风险，并考虑了竞争风险。

结果：在总体人群中，11,024 名患者在 7.4 年的中位随访期内发展为 HCC。 HCC 的累积发病率随着代谢危险因素负担的增加而增加（P<.0001；图 A）。在具有≤2 个代谢危险因素（13,104 对）的患者中，阿司匹林使用者的 HCC 累积发病率显着低于非使用者（P=.005；B 组）；然而，多变量调整后，阿司匹林的使用与较低的 HCC 风险无关（调整后的风险比 [HR]，0.93；95% 置信区间 [CI]，0.84-1.03；P=.18）。在具有≥3 个代谢危险因素（2,984 对）的患者中，与不使用阿司匹林的患者相比，使用阿司匹林的累积 HCC 发生率显着降低（P=.005；图 C），并且使用阿司匹林与降低 28% 的 HCC 风险相关（调整后的 HR，0.72 ；95% CI，0.57–0.91；P=.006）。

结论：在这项韩国全国性队列研究中，在代谢风险因素负担较高的非肝硬化 CHB 患者中，每天使用阿司匹林与降低 HCC 风险相关。

StephenW

ASSOCIATION BETWEEN DAILY ASPIRIN THERAPY AND HEPATOCELLULAR CARCINOMA ACCORDING TO METABOLIC
RISK FACTOR BURDEN IN PATIENTS WITH CHRONIC HEPATITIS B
AASLD 2021 Nov 12-15

Cheol-Hyung Lee1,2, Yun Bin Lee1, Hyemi Moon3, Jong-Won Chung4, Eun Ju Cho1, Jeong-Hoon Lee1, Su Jong Yu1, Yoon Jun Kim1, Juneyoung Lee3 and Jung-Hwan Yoon1, (1) Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea, (2)The Armed Forces Medical Command, Seongnam, Republic of Korea, (3)Department of Biostatistics, College of Medicine, Korea University, (4)Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Background: Several studies have provided evidence supporting chemopreventive effect of aspirin against hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) patients. Recently, we demonstrated that daily aspirin use was associated with reduced HCC risk in non-cirrhotics with CHB, but not in cirrhotics. To identify better candidates for daily aspirin therapy, we investigated the association of aspirin use with HCC risk according to metabolic risk factor burden, which is an independent risk factor of HCC, among non-cirrhotics with CHB.

Methods: We collected baseline data on metabolic risk factors, including obesity, high blood pressure, hypercholesterolemia, and diabetes, in 282,611 adult non-cirrhotics with CHB using the Korean National Health Insurance Service database. The study patients were stratified according to the number of metabolic risk factors, after which propensity score-matched cohorts were generated to balance baseline characteristics between aspirin users and nonusers. The risk of HCC was analyzed, accounting for competing risks.

Results: In overall population, 11,024 patients developed HCC during a median follow-up period of 7.4 years. The cumulative incidences of HCC rose with increasing metabolic risk factor burden (P<.0001; panel A). Among patients with ≤2 metabolic risk factors (13,104 pairs), the cumulative incidences of HCC in aspirin users were significantly lower than in nonusers (P=.005; panel B); however, aspirin use was not associated with lower HCC risk after multivariable adjustment (adjusted hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.84–1.03; P=.18). Among patients with ≥3 metabolic risk factors (2,984 pairs), aspirin users showed significantly lower cumulative HCC incidences compared to nonusers (P=.005; panel C) and aspirin use was associated with 28% reduced risk of HCC (adjusted HR, 0.72; 95% CI, 0.57–0.91; P=.006).

Conclusion: In this Korean nationwide cohort study, daily aspirin use was associated with reduced risk of HCC in non-cirrhotic CHB patients with higher burden of metabolic risk factors.

StephenW

咨询你的医生，每天服用阿司匹林有内出血的风险