Aspirin Use and Survival After Diagnosis of Colorectal Cancer

被引:448
作者
Chan, Andrew T. [1 ,5 ]
Ogino, Shuji [2 ,3 ,4 ]
Fuchs, Charles S. [4 ,5 ]
机构
[1] Massachusetts Gen Hosp, Gastrointestinal Unit, Boston, MA 02114 USA
[2] Harvard Univ, Sch Med, Dept Pathol, Brigham & Womens Hosp, Boston, MA 02115 USA
[3] Harvard Univ, Sch Publ Hlth, Dept Epidemiol, Boston, MA 02115 USA
[4] Dana Farber Canc Inst, Dept Med Oncol, Boston, MA 02115 USA
[5] Brigham & Womens Hosp, Dept Med, Channing Lab, Boston, MA USA
来源
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2009年 / 302卷 / 06期
关键词
CYCLOOXYGENASE-2; GENE-EXPRESSION; FOOD FREQUENCY QUESTIONNAIRE; MALE HEALTH-PROFESSIONALS; NATIONAL DEATH INDEX; COLON-CANCER; LIVER METASTASIS; RANDOMIZED-TRIAL; UP-REGULATION; HEMATOGENOUS METASTASIS; SELECTIVE-INHIBITION;
D O I
10.1001/jama.2009.1112
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context Aspirin reduces risk of colorectal neoplasia in randomized trials and inhibits tumor growth and metastases in animal models. However, the influence of aspirin on survival after diagnosis of colorectal cancer is unknown. Objective To examine the association between aspirin use after colorectal cancer diagnosis on colorectal cancer-specific and overall survival. Design, Setting, and Participants Prospective cohort study of 1279 men and women diagnosed with stage I, II, or III colorectal cancer. Participants were enrolled in 2 nationwide health professional cohorts in 1980 and 1986 prior to diagnosis and followed up through June 1, 2008. Main Outcome Measure Colorectal cancer-specific and overall mortality. Results After a median follow-up of 11.8 years, there were 193 total deaths (35%) and 81 colorectal cancer-specific deaths (15%) among 549 participants who regularly used aspirin after colorectal cancer diagnosis, compared with 287 total deaths (39%) and 141 colorectal cancer-specific deaths (19%) among 730 participants who did not use aspirin. Compared with nonusers, participants who regularly used aspirin after diagnosis experienced a multivariate hazard ratio (HR) for colorectal cancer-specific mortality of 0.71 (95% confidence interval [CI], 0.53-0.95) and for overall mortality of 0.79 ( 95% CI, 0.65-0.97). Among 719 participants who did not use aspirin before diagnosis, aspirin use initiated after diagnosis was associated with a multivariate HR for colorectal cancer-specific mortality of 0.53 ( 95% CI, 0.33-0.86). Among 459 participants with colorectal cancers that were accessible for immunohistochemical assessment, the effect of aspirin differed significantly according to cyclooxygenase 2 (COX-2) expression (P for interaction = .04). Regular aspirin use after diagnosis was associated with a lower risk of colorectal cancer-specific mortality among participants in whom primary tumors overexpressed COX-2 ( multivariate HR, 0.39; 95% CI, 0.20-0.76), whereas aspirin use was not associated with lower risk among those with primary tumors with weak or absent expression ( multivariate HR, 1.22; 95% CI, 0.36-4.18). Conclusion Regular aspirin use after the diagnosis of colorectal cancer is associated with lower risk of colorectal cancer-specific and overall mortality, especially among individuals with tumors that overexpress COX-2. JAMA. 2009; 302(6):649-659 www.jama.com
引用
收藏
页码:649 / 659
页数:11
相关论文
共 67 条
[1]  
[Anonymous], 1992, AM J EPIDEMIOL
[2]  
[Anonymous], 2002, AJCC CANC STAGING HD
[3]   Cyclooxygenase-2 inhibitors in colorectal cancer prevention: Point [J].
Arber, Nadir .
CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION, 2008, 17 (08) :1852-1857
[4]   Celecoxib for the prevention of colorectal adenomatous polyps [J].
Arber, Nadir ;
Eagle, Craig J. ;
Spicak, Julius ;
Racz, Istvan ;
Dite, Petr ;
Hajer, Jan ;
Zavoral, Miroslav ;
Lechuga, Maria J. ;
Gerletti, Paola ;
Tang, Jie ;
Rosenstein, Rebecca B. ;
Macdonald, Katie ;
Bhadra, Pritha ;
Fowler, Robert ;
Wittes, Janet ;
Zauber, Ann G. ;
Solomon, Scott D. ;
Levin, Bernard .
NEW ENGLAND JOURNAL OF MEDICINE, 2006, 355 (09) :885-895
[5]   A randomized trial of aspirin to prevent colorectal adenomas [J].
Baron, JA ;
Cole, BF ;
Sandler, RS ;
Haile, RW ;
Ahnen, D ;
Bresalier, R ;
McKeown-Eyssen, G ;
Summers, RW ;
Rothstein, R ;
Burke, CA ;
Snover, DC ;
Church, TR ;
Allen, JI ;
Beach, M ;
Beck, GJ ;
Bond, JH ;
Byers, T ;
Greenberg, ER ;
Mandel, JS ;
Marcon, N ;
Mott, LA ;
Pearson, L ;
Saibil, F ;
van Stolk, RU .
NEW ENGLAND JOURNAL OF MEDICINE, 2003, 348 (10) :891-899
[6]   A randomized trial of rofecoxib for the chemoprevention of colorectal adenomas [J].
Baron, John A. ;
Sandler, Robert S. ;
Bresalier, Robert S. ;
Quan, Hui ;
Riddell, Robert ;
Lanas, Angel ;
Bolognese, James A. ;
Oxenius, Bettina ;
Horgan, Kevin ;
Loftus, Susan ;
Morton, Dion G. .
GASTROENTEROLOGY, 2006, 131 (06) :1674-1682
[7]   Daily soluble aspirin and prevention of colorectal adenoma recurrence: One-year results of the APACC trial [J].
Benamouzig, R ;
Deyra, J ;
Martin, A ;
Girard, B ;
Jullian, E ;
Piednoir, B ;
Couturier, D ;
Coste, T ;
Little, J ;
Chaussade, S .
GASTROENTEROLOGY, 2003, 125 (02) :328-336
[8]   Celecoxib for the prevention of sporadic colorectal adenomas [J].
Bertagnolli, Monica M. ;
Eagle, Craig J. ;
Zauber, Ann G. ;
Redston, Mark ;
Solomon, Scott D. ;
Kim, KyungMann ;
Tang, Jie ;
Rosenstein, Rebecca B. ;
Wittes, Janet ;
Corle, Donald ;
Hess, Timothy M. ;
Woloj, G. Mabel ;
Boisserie, Frederic ;
Anderson, William F. ;
Viner, Jaye L. ;
Bagheri, Donya ;
Burn, John ;
Chung, Daniel C. ;
Dewar, Thomas ;
Foley, T. Raymond ;
Hoffman, Neville ;
Macrae, Finlay ;
Pruitt, Ronald E. ;
Saltzman, John R. ;
Salzberg, Bruce ;
Sylwestrowicz, Thomas ;
Gordon, Gary B. ;
Hawk, Ernest T. .
NEW ENGLAND JOURNAL OF MEDICINE, 2006, 355 (09) :873-884
[9]   COX-2: A molecular target for colorectal cancer prevention [J].
Brown, JR ;
DuBois, RN .
JOURNAL OF CLINICAL ONCOLOGY, 2005, 23 (12) :2840-2855
[10]   Up-regulation of the enzymes involved in prostacyclin synthesis via Ras induces vascular endothelial growth factor [J].
Buchanan, FG ;
Chang, WK ;
Sheng, HM ;
Shao, JY ;
Morrow, JD ;
DuBois, RN .
GASTROENTEROLOGY, 2004, 127 (05) :1391-1400