Aspirin for the Chemoprevention of Colorectal Adenomas: Meta-analysis of the Randomized Trials

被引:363
作者
Cole, Bernard F. [1 ,8 ]
Logan, Richard F. [2 ]
Halabi, Susan [3 ,4 ]
Benamouzig, Robert [5 ]
Sandler, Robert S. [6 ]
Grainge, Matthew J. [2 ]
Chaussade, Stanislas [7 ]
Baron, John A. [8 ,9 ]
机构
[1] Univ Vermont, Dept Math & Stat, Burlington, VT 05401 USA
[2] Univ Nottingham, Dept Epidemiol & Publ Hlth, Queens Med Ctr, Nottingham NG7 2RD, England
[3] Duke Univ, Med Ctr, Dept Biostat & Bioinformat, Durahm, NC USA
[4] Duke Univ, Med Ctr, Canc & Leukemia Grp B Stat Ctr, Durahm, NC USA
[5] Hop Avicenne, Dept Gastroenterol, F-93009 Bobigny, France
[6] Univ N Carolina, Sch Med, Dept Med, Chapel Hill, NC USA
[7] Univ Paris 05, Hop Cochin, Dept Gastroenterol, Paris, France
[8] Dartmouth Coll, Hitchcock Med Ctr, Dartmouth Med Sch, Dept Community & Family Med, Hanover, NH 03756 USA
[9] Dartmouth Coll, Hitchcock Med Ctr, Dartmouth Med Sch, Dept Med, Hanover, NH 03756 USA
来源
JNCI-JOURNAL OF THE NATIONAL CANCER INSTITUTE | 2009年 / 101卷 / 04期
关键词
NONSTEROIDAL ANTIINFLAMMATORY DRUGS; CYCLOOXYGENASE-2; INHIBITOR; PRIMARY PREVENTION; RECTAL POLYPS; DOUBLE-BLIND; RISK; SULINDAC; CANCER;
D O I
10.1093/jnci/djn485
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background Multiple lines of evidence indicate that aspirin has an antineoplastic effect in the large bowel. Randomized clinical trials have been conducted to evaluate the effectiveness of aspirin for reducing the risk of colorectal adenomas. A meta-analysis of these trials will provide more precise estimates of the aspirin effect, both overall and in subgroups. Methods We combined data from all randomized double-blind placebo-controlled trials that evaluated aspirin for the prevention of colorectal adenomas. We used random-effects meta-analysis to estimate risk ratios and 95% confidence intervals (CIs) for the effect of aspirin on the occurrence of adenomas and of advanced lesions (ie, tubulovillous adenomas, villous adenomas, adenomas >= 1 cm in diameter, adenomas with high-grade dysplasia, or invasive cancer). All statistical tests were two-sided. Results We identified four clinical trials with 2967 randomly assigned participants. Each trial evaluated aspirin for the secondary prevention of colorectal adenomas. Doses of aspirin tested ranged from 81 to 325 mg/d. The average age of participants at baseline was 58 years, and 60% were male. Median follow-up was 33 months. A total of 2698 participants underwent colonoscopic follow-up and were included in the analysis of adenoma occurrence and advanced-lesion occurrence after randomization. Among these participants, adenomas were found in 424 (37%) of the 1156 participants allocated to placebo and in 507 (33%) of the 1542 participants allocated to any dose of aspirin. Advanced lesions were found in 12% of participants in the placebo group and in 9% of participants allocated to any dose of aspirin. The pooled risk ratio of any adenoma for any dose of aspirin vs placebo was 0.83 (95% CI = 0.72 to 0.96). This corresponded to an absolute risk reduction of 6.7% (95% CI = 3.2% to 10.2%). For any advanced lesion, the pooled risk ratio was 0.72 (95% CI = 0.57 to 0.90). We found no statistically significant effect modification for any of the baseline factors studied. Conclusion Aspirin is effective for the prevention of colorectal adenomas in individuals with a history of these lesions. J Natl Cancer Inst 2009; 101: 256-266
引用
收藏
页码:256 / 266
页数:11
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