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Aspirin Lowers HCC Risk in Hep B Patients
Retrospective analysis shows benefit, but expert considers practice changes premature
Daily aspirin is significantly associated with a reduced risk for liver cancer in patients with hepatitis B virus (HBV), according to an analysis of data from a nationwide cohort study.
The findings, presented at the 2017 Liver Meeting (abstract 223), showed that aspirin cut the incidence of liver cancer from 5.59% to 2.86% in patients with HBV.
Investigator Teng-Yu Lee, MD, PhD, MBA, a researcher in the Department of Gastroenterology at Taichung Veterans General Hospital, in Taiwan, said the information may help prevent HBV-related liver cancer in “patients with chronic HBV infection, particularly … those who are not indicated for antiviral therapy.”
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Multiple clinical studies have demonstrated a link between long-term use of aspirin and a reduction in the incidence and mortality of several cancer types, including colorectal, stomach, esophageal, breast, lung, prostate and liver cancer (Lancet 2011;377:31-41). Research also has demonstrated that aspirin can reduce cancer risk, particularly in the presentation of colorectal cancer (Clin Cancer Res 2014;20:1087-1094).
In the new study, Dr. Lee and his colleagues retrieved medical records from the National Health Insurance Research Database in Taiwan between 1998 and 2012 and screened the records of 204,507 patients with chronic HBV infection. They excluded patients who had other forms of infectious hepatitis and who already had been diagnosed with hepatocellular carcinoma (HCC). A cohort of 1,553 patients who had continuously received daily aspirin for at least 90 days were randomly matched on a 1:4 basis with 6,212 patients who had never received antiplatelet therapy using propensity scores consisting of baseline characteristics, the index date and use of nucleos(t)ide analog during follow-up.
The patients who received aspirin had a lower incidence of HCC than the nonaspirin group at five years (2.86% vs. 5.59%; P<0.01). In a multivariable regression analysis, aspirin therapy was independently associated with a reduced HCC risk (hazard ratio, 0.63; P=0.002). Sensitivity subgroup analyses also verified this association. Use of nucleos(t)ide analogs or statins also was associated with a decreased HCC risk. Older age, male sex, cirrhosis and diabetes were independently associated with an increased risk.
Dr. Lee said the research team was pursuing prospective investigations to further confirm the findings.
Timothy R. Morgan, MD, the chief of hepatology at VA Long Beach Healthcare System, in California, and a professor of medicine in the Division of Gastroenterology at the University of California, Irvine, said more evidence is needed about the benefits of aspirin before he would make any practice changes. “Based on the abstract,” he said, “I would not recommend that patients with HBV start taking aspirin to reduce their risk of liver cancer.”
—Kate O’Rourke
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