Abstract
BackgroundMany studies have found that use of aspirin can lengthen survival in patients with gastrointestinal cancer. The aim of this study was to assess the survival benefit of aspirin use compared with non-aspirin use for patients with esophageal, gastric or colorectal cancer.MethodsWe searched online databases, including PubMed, the Cochrane Library, Embase and www.clinicaltrials.gov for studies that were conducted, before April 30th, 2020, to identify relevant studies. Overall survival and cancer-specific survival of esophageal, gastric and colorectal cancers among aspirin users were compared with those among non-aspirin users. Data extraction and quality evaluation were independently conducted by 2 investigators. A meta-analysis was performed to calculate the pooled risk ratios (RRs) for overall survival and cancer-specific survival by using either a fixed-effects model or a random-effects model.ResultsA total of 18 studies were included in this meta-analysis, with more than 74,936 patients. There were no significant differences between postdiagnosis aspirin use and overall survival for esophageal and gastric cancers. For colorectal cancer, a benefit that was associated with postdiagnosis aspirin use was observed for overall survival and cancer-specific survival [HR = 0.83, 95%CI(0.75, 0.9.);HR = 0.78, 95%CI(0.66, 0.92), respectively. However, a prediagnosis of aspirin use did not provide a benefit for overall or cancer-specific survival in colorectal cancer. HR values for overall and cancer-specific survival benefits for colorectal cancer associated with both prediagnosis and postdiagnosis aspirin were as follows: HR = 0.75, 95%CI(0.61, 0.92) and HR = 0.78, 95%CI(0.73, 0.85), respectively. In addition, the survival benefit of postdiagnosis aspirin use appeared to be confined to patients with mutated PIK3CA tumors [HR = 0.78, 95%CI(0.50, 0.99)] and was positive for PTGS2 (COX-2) expression [HR = 0.75, 95%CI(0.43, 1.30)].ConclusionsThese findings provide further indications that postdiagnosis aspirin use improves overall survival and cancer-specific survival in colorectal cancer, especially for patients who are positive for PTGS2 (COX-2) expression and PIK3CA-mutated tumors. However, aspirin therapy does not improve overall survival in esophageal and gastric cancers, although the meta-analysis was mainly limited to retrospective studies.
Highlights
Many studies have found that use of aspirin can lengthen survival in patients with gastrointestinal cancer
Inclusion and exclusion criteria The inclusion criteria were as follows: (1) Random control trials (RCTs) or observational studies including cohort and case-control studies; (2) the outcomes of interest beingdefined as Overall survival (OS) and Cancer-specific survival (CSS) of esophageal, gastric, colorectal, colon or rectal cancer; (3) the study addressing aspirin usage at the times of prediagnosis and/or postdiagnosis of esophageal, gastric, colorectal, colon or rectal cancer; (4) HR or OR estimates with 95% CIs were available
One study involving 750 patients compared the cancer-specific survival of gastric cancer among aspirin users with non-aspirin users, and the HRs revealed no significant differences between the groups [HR = 0.70, 95% CI (0.29, 1.69)] (Fig. 1b)
Summary
Many studies have found that use of aspirin can lengthen survival in patients with gastrointestinal cancer. The aim of this study was to assess the survival benefit of aspirin use compared with non-aspirin use for patients with esophageal, gastric or colorectal cancer. It is urgent to discover a more effective comprehensive treatment for gastrointestinal malignancies. Many studies [2,3,4,5,6,7] have found that aspirin has anticancer effects. As there are still some controversy about these studies, the aim of this study was to assess the survival benefits of aspirin use (compared with non-aspirin use) for esophageal, gastric and colorectal cancer patients through the use of a meta-analysis
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