每日服用阿司匹林可降低HBV相关的肝细胞癌风险

StephenW

Daily aspirin may reduce HBV-related hepatocellular carcinoma risk

Fox RK, et al. JAMA Intern Med. 2019;doi:10.1001/jamainternmed.2018.8314.
Lee TY, et al. JAMA Intern Med. 2019;doi:10.1001/jamainternmed.2018.8342.
March 18, 2019

The risk for hepatocellular carcinoma was statistically significantly reduced by 29% in patients with hepatitis B virus who received daily aspirin, according to findings published in JAMA Internal Medicine.

“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,” Teng-Yu Lee, MD, MBA, PhD, from the division of gastroenterology and hepatology at the Taichung Veterans General Hospital, Taiwan, and colleagues wrote. “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.”

Lee and colleagues conducted a nationwide cohort study in Taiwan to determine how daily aspirin therapy affects HBV-related HCC risk. Between 1997 and 2012, the researchers recruited and screened 204,507 patients with chronic HBV.

Patients with confounding conditions were excluded, making a total of 10,615 participants (72.4% men; mean age, 58.8 years). The researchers randomly propensity score-matched 2,123 patients who received daily aspirin for 90 or more consecutive days (treated group) to 8,492 patients who had never received antiplatelet therapy (untreated group) at a 1:4 ratio.

At 5 years, patients in the treated group had a significantly lower cumulative incidence of HCC than those in the untreated group (5.2% vs. 7.87%).

The researchers observed an independent association between aspirin therapy and reduced HCC risk (HR = 0.71; 95% CI, 0.58-0.86) in the multivariable regression analysis. This association was confirmed in sensitivity subgroup analyses.

There was also an independent association between increased HCC risk and older age (HR = 1.01 per year; 95% CI, 1-1.02), male sex (HR = 1.75; 95% CI, 1.43-2.14) and cirrhosis (HR = 2.89; 95% CI, 2.45-3.4). Conversely, nucleos(t)ide analogue (HR = 0.54; 95% CI, 0.41-0.71) and statin use (HR = 0.62; 95% CI, 0.42-0.9) were associated with a decreased HCC risk.

“Daily aspirin therapy may be of help to further improve the chemoprevention of HBV–related hepatocellular carcinoma,” Lee and colleagues concluded.

“Before aspirin therapy is broadly adopted for HCC prevention in practice, a prospective trial should be conducted to assess its efficacy and safety,” they added.

In an accompanying editorial, Rena K. Fox, MD, professor of medicine at the University of California, San Francisco, and colleagues wrote that although the findings by Lee and colleagues improve upon current research, there were limitations of the cohort and study methods, such as the low frequency of aspirin users, that require more examination.

“With the rising incidence and deaths due to HCC across the globe, there is a need for uncomplicated, inexpensive, and effective interventions to reduce HCC incidence,” they wrote. “Patients with HBV are particularly at risk of HCC, and although there is a beneficial role of nucleos(t)ide analogues therapy, because so many patients are not candidates for or lack access to antivirals, an agent such as aspirin holds promise.”

“The potential role for aspirin to be used as chemoprevention for HCC would be relevant to patients worldwide and would bring a change in practice for primary care clinicians and specialists, including gastroenterology, hepatology, infectious diseases, and oncology,” they added. – by Alaina Tedesco



Disclosures: Fox and colleagues report no relevant financial disclosures. Lee reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.

StephenW

每日服用阿司匹林可降低HBV相关的肝细胞癌风险

Fox RK，et al。 JAMA Intern Med。 2019; DOI：10.1001 / jamainternmed.2018.8314。
李TY，等。 JAMA Intern Med。 2019; DOI：10.1001 / jamainternmed.2018.8342。
2019年3月18日

根据JAMA Internal Medicine发表的研究结果，接受每日服用阿司匹林的乙型肝炎病毒患者的肝细胞癌风险在统计学上显着降低了29％。

“抗病毒治疗不能消除慢性乙型肝炎患者的肝细胞癌（HCC）风险，而且对于大多数乙型肝炎病毒（HBV）携带者而言并不适用，”Teng-Yu Lee，MD，MBA，PhD，来自胃肠病学科台湾台中退伍军人总医院和同事写道。 “需要开发另一种降低HCC风险的有效方法。阿司匹林可能会预防癌症的发展，但HBV相关HCC患者的临床证据仍然有限。“

Lee及其同事在台湾进行了一项全国性队列研究，以确定每日阿司匹林治疗如何影响HBV相关的HCC风险。 1997年至2012年间，研究人员招募并筛选了204,507例慢性HBV患者。

患有混杂病症的患者被排除在外，共有10,615名参与者（72.4％为男性;平均年龄为58.8岁）。研究人员随机倾向评分匹配2,123例连续90天或以上接受过阿司匹林治疗的患者（治疗组）至8,492例未接受抗血小板治疗（未治疗组）的患者，比例为1：4。

在5年时，治疗组中的患者HCC累积发生率显着低于未治疗组（5.2％对7.87％）。

研究人员在多变量回归分析中观察到阿司匹林治疗与降低HCC风险（HR = 0.71; 95％CI，0.58-0.86）之间的独立关联。这种关联在敏感性亚组分析中得到证实。

HCC风险增加与年龄较大（HR = 1.01 /年; 95％CI，1-1.02），男性（HR = 1.75; 95％CI，1.43-2.14）和肝硬化（HR = 2.89）之间存在独立关联。 ; 95％CI，2.45-3.4）。相反，核苷（t）ide类似物（HR = 0.54; 95％CI，0.41-0.71）和他汀类药物使用（HR = 0.62; 95％CI，0.42-0.9）与降低的HCC风险相关。

“每日阿司匹林治疗可能有助于进一步改善HBV相关肝细胞癌的化学预防，”Lee及其同事总结道。

“在实践中广泛采用阿司匹林治疗进行HCC预防之前，应进行前瞻性试验以评估其疗效和安全性，”他们补充说。

加利福尼亚大学旧金山分校的医学教授Rena K. Fox及其同事在一篇随刊的社论中写道，尽管Lee及其同事的研究结果改进了目前的研究，但是队列和研究方法存在局限性，例如阿司匹林使用者的频率较低，需要更多的检查。

他们写道：“由于HCC在全球范围内的发病率和死亡人数不断增加，因此需要采用简单，廉价和有效的干预措施来降低HCC的发病率。” “HBV患者特别容易患HCC，尽管核苷（t）类似物治疗有益，但由于许多患者不适合或无法获得抗病毒药物，因此阿司匹林等药物具有前景。”

他们补充说：“阿司匹林用作HCC化学预防的潜在作用将与全球患者相关，并将为初级保健临床医生和专家带来改变，包括胃肠病学，肝病学，传染病和肿瘤学。” - 由Alaina Tedesco提供



披露：Fox和同事报告没有相关的财务披露。李报告没有相关的财务披露。有关所有其他作者的相关财务披露，请参阅研究。