Study: aspirin and colon cancer

Veröffentlicht:

Von:

Referenz Bains SJ, Mahic M, Myklebust TÅ, et al. Aspirin als Sekundärprävention bei Patienten mit Darmkrebs: eine unselektierte populationsbasierte Studie. J Clin Oncol. 2016;34(21):2501-2508. Design Beobachtende, bevölkerungsbezogene, retrospektive Kohortenstudie Zielsetzung Um zu beurteilen, ob die Anwendung von Aspirin bei Patienten mit Darmkrebs (CRC) in der Vorgeschichte das Gesamtüberleben oder das CRC-spezifische Überleben beeinflusst Teilnehmer Die Studie wurde in Norwegen unter Verwendung staatlicher Gesundheitsdatenbanken zur Geschichte von CRC, Aspirinkonsum (Aspirin ist in Norwegen verschreibungspflichtig) und Todesursachen durchgeführt. Dieses System bietet eine randomisierte Kohorte durch die Aufnahme aufeinanderfolgender Patienten, die die Kriterien erfüllen, die Verschlüsselung persönlicher Informationen und ein validiertes Mittel zur …
Reference Bains SJ, Mahic M, Myklebust Tå, et al. Aspirin as a secondary prevention in patients with colon cancer: an unselected population -based study. J clin oncol. 2016; 34 (21): 2501-2508. Design-observed, population-related, retrospective cohort study aims to assess whether the use of aspirin in patients with colon cancer (CRC) In history, overall survival or the CRC-specific survival. Participants influenced in Norway using state health databases on the history of CRC, aspirin consumption is prescribed in Norway) Causes of death carried out. This system offers a randomized cohort through the absorption of successive patients who meet the criteria, the encryption of personal information and a validated means of ... (Symbolbild/natur.wiki)

Reference

bains SJ, Mahic M, Myklebust Tå, et al. Aspirin as a secondary prevention in patients with colon cancer: an unselected population -based study. J clin oncol. 2016; 34 (21): 2501-2508.

Design

observed, populated, retrospective cohort study

objective

to assess whether the use of aspirin in patients with colon cancer (CRC) in the history of the overall survival or the CRC-specific survival

participant

The study was carried out in Norway using state health databases on the history of CRC, aspirin consumption (aspirin is prescribed in Norway) and causes of death. This system offers a randomized cohort through the absorption of successive patients who meet the criteria, the encryption of personal information and a validated means of obtaining relevant data, with almost no one lost for aftercare. The participants were the ones who were diagnosed between January 2004 and December 2011. Patients in every stage (from stage I to stage IV) who only had a diagnosis of CRC and had histological references to adenocarcinoma with known topography (place of tumor participation) were included. There were 23,162 participants who met the criteria for the analysis and 88.9 % of all participants underwent a surgical resection of their tumors. All participants were over 18 years old (mean = 71.5 years).

Intervention

Subsequent application of gastrointestinal -resistant aspirin, either 75 mg per day or 160 mg per day, as stated by The Norwegian Prescription Database

target parameter

participants who revenue (n = 6.102) for at least 6 months were compared to those who do not have an aspirin (those who filled out less than 3 recipes were considered as non -users; n = 17,060). In a subgroup analysis, the group, which aspirin took both before and after the CRC diagnosis (user before and after the diagnosis; n = 4,391), was analyzed separately from the group that only took aspirin after the diagnosis (user after diagnosis; n = 1.711). ) and each group compared to the group of aspirin-not consumers. The data analysis excluded the first 30 days after the resection to rule out surgical complications as the cause of death. The inclusion of the participants continued until death, emigration or the final date of the study (December 2013).

important knowledge

There were a total of 2,071 deaths from all causes (32.9 %), and 1,158 (19 %) of which were due to CRC for aspirin consumers (n = 6.102). Among the Aspirin Niche users (n = 17,060) there were 7,218 (42.3 %) deaths due to all causes, including 5,375 (31.5 %) CRC-specific deaths. In a multivariablic analysis, taking aspirin was associated with a 15 % reduced risk for CRC-specific deaths (Hazard Ratio [HR]: 0.85; 95 % confidence interval [CI]: 0.79–0.92; p <0.001) and a downward trend for death by any cause by 5 % (HR: 0.95; 95 % KI: 0.90–1.01; p = 0.076). This effect was more pronounced among those who took aspirin both before and after their CRC diagnosis; They had a 23 % improvement in the CRC-specific survival (HR: 0.77; 95 % KI: 0.71-0.84; p <0.001) and an improvement in overall survival by 14 % (HR: 0.86; 95 % KI: 0.81–0,92; p <0.001). By using a time -dependent coefficient model, the authors showed that the use of aspirin was most advantageous in the first 2 to 3 years after the diagnosis.

Comment

According to the National Cancer Institute, an estimated 1.3 million cases of CRC are diagnosed every year. In the United States, the screening has reduced both the incidence and the mortality of CRC. 1 Despite this limited success, CRC still remains the third most common cancer diagnosis in America (after lung, breast or prostate cancer) and the second most common cause of death due to cancer. Probably that every doctor will work with CRC patients in history.
Maybe there is no easier but more profound advice that we can give these patients than just take a baby aspirin every day. If this were the only study so far that indicates benefits, the advice could sound hollow, especially if you consider that the aspirine consumers in this study had some significant tendencies that may have had additional positive effects (tumors in the group of aspirone tenders were most likely diagnosed in a previous stage and have a less aggressive pathology).
However, this is not the first study that indicates that aspirin has an advantage in CRC's forecast. In 2009, Chan and colleagues reported results that combined 2 potential cohorts (1279 men and women) from participants with a history of CRC. They found a 29 percent reduction in the CRC-specific mortality and a 21 percent reduction in the overall mortality of CRC patients who after a diagnosis of aspirin income (stadiums I-III). 2 Chan and colleagues continued and tested the cyclooxygenase (COX) -2 overexpression in the original tumors. They found that CRC-specific mortality was reduced by 61 % when the tumors overexpressed (HR: 0.39; CI: 0.20–0.76). In patients whose tumors COX-2 did not over-impressed, however, there was no benefit from the intake of aspirin (HR: 1.22; KI: 0.36–4.18).
In these studies, low-dosed aspirin (81 mg) has a positive effect by either reducing relapses, reducing CRC-specific deaths and/or reducing the overall mortality.
Since Chan publication, successor studies and overview work have confirmed the advantageous role of using aspirin in patients with CRC in the history. 3-7 In these studies, low-dose aspirin (81 mg) has a positive effect by either reducing relapses, reducing CRC-specific deaths and/or reducing the overall degree. Of course, the potential advantages of aspirin against the risks of mild bruises, internal bleeding of the gastrointestinal tract and hemorrhagic risks, including strokes in older people, must be weighed. predominates. 9 Every patient should be extensively informed about the risks and monitored on possible side effects of aspirin.
Those of us who deal with integrative oncology spend a lot of time to understand how nutrition, microbiota, sleep, movement and spirit-body practices influence the risk of cancer or recurrence. All of these are essential efforts to improve the current quality of life and durability of our patients. Much of our education and working with every patient includes big changes in nutrition or lifestyle. Much of it also requires a level of commitment that can or not be peculiar to each patient. Ultimately, it is our goal to help our patients a good and long life. For this purpose, we have to remember to consider baby aspirin as a simple, evidence-based, non-toxic intervention for our patients with CRC in history.

  1. National Cancer Institute. Several and rectal cancer: Seer Stat Fact Sheets. http://seer.cancer.gov/statfacts/html/colorect.html . Accessed on October 27, 2016.
  2. Chan at, Ogino S, Fuchs CS. Use of aspirin and survival for the diagnosis of colon cancer. Jama . 2009; 302 (6): 649-658.
  3. Goh Ch, Leong WQ, Chew Mh, et al. Postoperative Aspiring Brain and Colorectal Cancer-specific survival in patients with colon cancer in the I-III stage. anti-cancer-res . 2014; 34 (12): 7407-7414.
  4. Reimers MS, Bastiaannet E, van Herk-Sukel Mpp, et al. j am Geriatr Soc . 2012; 60 (12): 2232-2236.
  5. Bastiaannet E., Sampieri K., Dekkers Om, et al. The use of aspirin after diagnosis improves the survival of colon cancer patients. br j Krebs . 2012; 106 (9): 1564-1570.
  6. Ye XF, Wang J, Shi WT, He J. Connection between the use of aspirin after the diagnosis of colon cancer and the survival of the patient: a meta -analysis of observation studies. br j Krebs . 2014; 111 (11): 2172-2179.
  7. Li P, Wu H, Zhang H, et al. The use of aspirin after diagnosis, but not before diagnosis, improves established survival in colon cancer: a meta-analysis. intestine . 2015; 64 (9): 1419-1425.
  8. Whitlock EP, Burda Bu, Williams SB, Guirguis-Blake JM, Evan's CV. Bleeding risks when using aspirin for primary prevention in adults: a systematic review for the US Preventive Services Task Force. ann internal med . 2016; 164 (12): 826-835.
  9. Whitlock EP, Williams SB, Burda Bu, Fightner A, Beil T, Ed. Aspirin Use in Adults: Cancer, All-Cause Mortality, and Harms: A Systematic Evidence Review for the Us Report No.: 13-05193-ef-1. Task Force for preventive services. Rockville, MD: Agency for Research and Quality in Health Care (USA); Us Preventive Services Task Force Evidence Syntheses, formerly Systematic Evidence Reviews; 2015.