Aspirin and non-steroidal anti-inflammatory drugs use reduce gastric cancer risk: A dose-response meta-analysis.

Xuan-Zhang Huang,Jian Wu,Cong-Cong Wu,You Chen,Xi Zhang,Shuang-Shuang Sun,Wen-Jun Chen,Chao-Ying Zhang

doi:10.18632/oncotarget.13591

Abstract

BackgroundThe association between non-steroidal anti-inflammatory drugs (NSAIDs) and gastric cancer (GC) risk is controversial. The aim of this study is to evaluate the chemopreventive effect of NSAIDs for GC.MethodsA literature search was performed for relevant studies using the PubMed and Embase database (up to March 2016). Risk ratios (RRs) and 95% confidence intervals (CIs) were used as the effect measures. The dose–response analysis and subgroup analysis were also performed.ResultsTwenty-four studies were included. Our results indicated that NSAIDs could reduce GC risk (any NSAIDs: RR=0.78, 96%CI=0.72-0.85; aspirin: RR=0.70, 95%CI=0.62-0.80; non-aspirin NSAIDs: RR=0.86, 95%CI=0.80-0.94), especially for non-cardia GC risk. Moreover, the dose-response analysis indicated the risk of GC decreased by 11% and 5% for 2 years increment of any NSAIDs and aspirin use, respectively. There were nonlinear relationships between the frequency of any NSAIDs use and aspirin use and GC risk (P for non-linearity<0.01), with a threshold effect of 5 times/week. A monotonically decreasing trend was observed only for the frequency of less than 5 times/week.ConclusionsOur results indicate that NSAIDs is inversely associated with GC risk, especially for non-cardia GC risk. NSAIDs use may become a feasible approach to prevent GC.

Highlights

Gastric cancer (GC) is one of the most frequently diagnosed cancer worldwide [1]
Our results indicated that non-steroidal anti-inflammatory drugs (NSAIDs) could reduce GC risk, especially for non-cardia GC risk
The dose-response analysis indicated the risk of GC decreased by 11% and 5% for 2 years increment of any NSAIDs and aspirin use, respectively

Summary

Introduction

Gastric cancer (GC) is one of the most frequently diagnosed cancer worldwide [1]. a decline in GC incidence has been observed due to the primary prevention strategies including increased consumption of fresh fruits and vegetables, decreased intake of salt-preserved foods, and reduction in Helicobacter pylori (H. pylori) infection and smoking, GC has a unsatisfying prognosis and still remains the third leading cause of cancer deaths [1, 2]. No meta-analyses conduct a dose–response analysis to evaluate the relationship between duration and www.impactjournals.com/oncotarget frequency of NSAIDs use and GC risk, and these published meta-analyses could not conclude that whether the chemopreventive effect is different according to different tumor sites (cardia and non-cardia GC) because cardia and non-cardia GC have different risk factors, tumor characteristics, and biological behavior [14,15,16]. Meta-analyses by Tian et al, Abnet et al and Bosetti et al do not evaluate the duration and frequency of NSAIDs use [11,12,13], and meta-analysis by Bosetti et al only assessed aspirin use and do not analyzed the effects of different tumor site [13]. The association between non-steroidal anti-inflammatory drugs (NSAIDs) and gastric cancer (GC) risk is controversial. The aim of this study is to evaluate the chemopreventive effect of NSAIDs for GC

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Conclusion