Abstract
BackgroundAspirin has been proposed as a novel adjuvant agent in colorectal cancer (CRC). Six observational studies have reported CRC-specific survival outcomes in patients using aspirin after CRC diagnosis but the results from these studies have been conflicting. Using a population-based cohort design this study aimed to assess if low-dose aspirin use after diagnosis reduced CRC-specific mortality.MethodsA cohort of 8391 patients with Dukes’ A-C CRC (2009–2012) was identified from the Scottish Cancer Registry and linked to national prescribing and death records. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for CRC-specific mortality were calculated using time-dependent Cox regression.ResultsThere were 1064 CRC-specific deaths after a median follow-up of 3.6 years. Post-diagnostic low-dose aspirin use was not associated with a reduction in CRC-specific mortality either before or after adjustment for confounders (adjusted HR = 1.17, 95% CI 1.00–1.36). In sensitivity analysis pre-diagnostic low-dose aspirin was also not associated with reduced CRC-specific mortality (adjusted HR = 0.96, 95% CI 0.88–1.05).ConclusionLow-dose aspirin use, either before or after diagnosis, did not prolong survival in this population-based CRC cohort.
Highlights
Aspirin has been proposed as a novel adjuvant agent in colorectal cancer (CRC)
Post-diagnostic aspirin use was not associated with reduced CRC-specific mortality after adjustment for potential confounders (HR = 1.17, 95% Confidence interval (CI) 1.00–1.36) (Table 2)
Post-hoc analysis confirmed there was a marked increase in cardiovascular deaths in postdiagnostic aspirin users compared to non-users
Summary
Aspirin has been proposed as a novel adjuvant agent in colorectal cancer (CRC). Six observational studies have reported CRC-specific survival outcomes in patients using aspirin after CRC diagnosis but the results from these studies have been conflicting. Using a population-based cohort design this study aimed to assess if low-dose aspirin use after diagnosis reduced CRC-specific mortality. Numerous observational studies and long term followup of randomised trials (of aspirin for cardiovascular indications) suggest that aspirin use is associated with a reduced risk of colorectal neoplasia [1]. Further evidence from long-term follow-up of these cardiovascular trials suggests aspirin could reduce metastases in CRC patients and could have utility in CRC treatment [4]. Additional studies assessing aspirin use after diagnosis and CRC survival are warranted to investigate the potential role of adjuvant aspirin treatment in CRC. We investigated whether post-diagnostic aspirin use was associated with improved CRC-specific mortality in a Scottish population-based CRC cohort
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