Abstract
BackgroundLow-dose aspirin use may reduce cancer incidence and mortality, but its influence on gastric adenocarcinoma survival is unclear. This study aimed to assess whether aspirin use improves long-term survival following gastrectomy for gastric adenocarcinoma.MethodsThis population-based cohort study included almost all patients who underwent gastrectomy for gastric adenocarcinoma in Sweden from 2006 to 2015, with follow-up throughout 2020. Preoperative exposure to a daily low-dose (75–160 mg) aspirin for 1 (main exposure), 2 and 3 years and for 1 year after gastrectomy was examined in relation to 5-year all-cause mortality (primary outcome) and disease-specific mortality. Multivariable Cox regression provided hazard ratios (HR) with 95% confidence intervals (CI), adjusted for age, sex, education, calendar year, comorbidity, statin use, tumour location, tumour stage, neoadjuvant chemotherapy, surgeon volume of gastrectomy and surgical radicality.ResultsAmong 2025 patients, 545 (26.9%) used aspirin at the date of gastrectomy. Aspirin use within 1 year before surgery did not decrease the adjusted risk of 5-year all-cause mortality (HR = 0.98, 95% CI 0.85–1.13) or disease-specific mortality (HR = 1.00, 95% CI 0.86–1.17). Preoperative aspirin use for 2 years (HR = 0.98, 95% CI 0.84–1.15) or 3 years (HR = 0.94, 95% CI 0.79–1.12) did not decrease the risk of 5-year all-cause mortality. Patients remaining on aspirin during the first year after gastrectomy had a similar 5-year all-cause mortality as non-users of aspirin (HR = 1.01, 95% CI 0.82–1.25).ConclusionsLow-dose aspirin use might not improve long-term survival after gastrectomy for gastric adenocarcinoma and may thus not be a target for adjuvant therapy in this group of patients.
Highlights
Gastric cancer (> 95% adenocarcinoma) is characterized by high incidence and poor survival, making it the third most common cause of cancer deaths globally [1]
The study included 2025 patients who underwent gastrectomy for gastric adenocarcinoma and they contributed a total of 5684 person-years and a mean of 2.8 person-years
Aspirin users were generally older, more often men, had lower education, more comorbidities, more statin use, more severe complications (Clavien Dindo ≥ 3), lower rate of neoadjuvant chemotherapy and a higher rate of sub-total compared to total gastrectomy, whereas other variables were more distributed (Table 1)
Summary
Gastric cancer (> 95% adenocarcinoma) is characterized by high incidence and poor survival, making it the third most common cause of cancer deaths globally [1]. Aspirin has been suggested to counteract tumour growth and metastases in adenomatous neoplasia, possibly through blocking the production of thromboxane A2 in platelets, which counteracts platelet aggregation and may reduce tumour spread [9, 10]. These results have prompted the initiation of randomized clinical trials assessing aspirin as a novel adjuvant treatment to surgery in patients with certain. Conclusions Low-dose aspirin use might not improve long-term survival after gastrectomy for gastric adenocarcinoma and may not be a target for adjuvant therapy in this group of patients
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