AASLD2020[747]阿司匹林减少肝细胞的发生 ETVTDF治疗的慢性癌患

StephenW

747
ASPIRIN REDUCES THE INCIDENCE OF HEPATOCELLULAR
CARCINOMA IN ETVTDF TREATED PATIENTS WITH CHRONIC
HEPATITIS B
Vicki Wing-Ki Hui, Department of Medicine and Therapeutics,
Institute of Digestive Disease, the Chinese University of Hong
Kong, Hong Kong.
Background: Aspirin is known to lower the incidence rates
of cancer (e g colorectal cancer) However, the effect of
aspirin use on the risk of chronic hepatitis B (CHB)-related
hepatocellular carcinoma (HCC) in patients receiving
antiviral treatment remains undetermined This study aimed
to investigate the impact of aspirin on reducing HCC risk in
patients treated with the first-line oral nucleos(t)ide analogues
(NAs; entecavir and/or tenofovir disoproxil fumarate) We also
reported the gastrointestinal safety of aspirin use Methods:
We conducted a territory-wide, retrospective cohort study in
NA-treated CHB patients between 2000 and 2018 from the
electronic healthcare data repository in Hong Kong Subjects
were classified into aspirin users for at least 90 days during
NA treatment (i.e. aspirin group); or no aspirin or any other
antiplatelet use during follow up period (i.e. no aspirin group)
Incidence rates of HCC and gastrointestinal bleeding (GIB)
in two groups were compared with Fine-Gray subdistribution
hazard regression with propensity score weighting Results:
Of 35,516 NA-treated CHB patients of mean age 53 1 years
and 61 6% male, 1451 (67 5%) belonged to aspirin group,
whereas 20,414 (61 2%) were in no aspirin group 83 (3 9%)
and 1488 (4 5%) developed HCC at a median [interquartile
range] of 2 7[1 4-4 9] years and 3 2[1 8-6 0] years in aspirin
use group and no aspirin use group, respectively The 5-year
cumulative incidence (95% CI) of HCC were 3 3% in aspirin
use group and 3 52% in no aspirin use group (absolute risk
difference (ARD): -0.22%; 95% confidence interval [CI]:
[-0 47%, -0 03%]; p = 0 012); that of GIB were 1 59% in aspirin
use group and 0 75% in no aspirin use group (ARD: 0 84%;
95% CI: [0 7%,0 99%]; p <0 001); Aspirin reduced the risk
of HCC (adjusted subdistributional hazard ratio (sHR): 0 60;
95% CI: [0 47, 0 77] ; p <0 001) The impact of aspirin use
on GIB was undetermined (sHR: 1 32; 95% CI: [0 90,1 95]
; p = 0 157) Conclusion: Aspirin reduces the risk of HCC
in NA-treated CHB patients without a significant increase in
the risk of adverse effects such as GIB Aspirin therapy may
be a chemoprophylactic agent in such patients who are at
significant risk of HCC.

StephenW

747
阿司匹林减少肝细胞的发生
ETVTDF治疗的慢性癌患者
乙型肝炎
医学与治疗学系许永基
香港中文大学消化系统疾病研究所
香港，香港。
背景：已知阿司匹林可降低发病率
癌症（例如大肠癌）的影响
阿司匹林对慢性乙型肝炎（CHB）相关风险的影响
接受肝细胞癌（HCC）的患者
尚不确定抗病毒治疗本研究旨在
调查阿司匹林对降低HCC风险的影响
一线口服核苷酸类似物治疗的患者
（NAs；恩替卡韦和/或替诺福韦富马酸替诺福韦）我们也
报道阿司匹林在胃肠道的安全使用方法：
我们在美国进行了一项全地区性回顾性队列研究
从2000年到2018年，NA治疗的CHB患者
香港的电子医疗数据存储库
在此期间至少90天被归类为阿司匹林使用者
NA治疗（即阿司匹林组）；或没有阿司匹林或任何其他
在随访期间使用抗血小板药物（即无阿司匹林组）
肝癌和胃肠道出血（GIB）的发生率
将两组的人与Fine-Gray子分布进行比较
倾向得分加权的风险回归结果：
35,516名接受NA治疗的CHB患者平均年龄53 1岁
阿司匹林组中男性占61 6％，其中1451人（占67 5％），
而没有阿司匹林组的患者有20,414（61 2％），有83人（3 9％）
和1488（4 5％）的HCC处于中位数[四分位数
阿司匹林的2 7 [1 4-4 9]年和3 2 [1 8-6 0]年
使用组和不使用阿司匹林的组分别为5年
阿司匹林的HCC累积发生率（95％CI）为3 3％
使用组，非阿司匹林使用组中有3 52％（绝对风险
差异（ARD）：-0.22％； 95％置信区间[CI]：
[-0 47％，-0 03％]; p = 0 012）；阿司匹林的GIB值为1 59％
使用组，无阿司匹林使用组为0 75％（ARD：0 84％；
95％CI：[0 7％，0 99％]； p <0001）；阿司匹林降低了风险
HCC（调整后的子分布危害比（sHR）：0 60；
95％CI：[0 47，0 77]； p <0 001）阿司匹林使用的影响
未确定是否接受GIB评估（sHR：1 32； 95％CI：[0 90,1 95]
; p = 0 157）结论：阿司匹林降低了HCC的风险
在接受NA治疗的CHB患者中，无明显增加
GIB阿司匹林治疗等不良反应的风险可能
在以下患者中成为化学预防剂
肝癌的重大风险。