S1160 Role of Aspirin in the Prevention of Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

Abstract

Introduction: Hepatocellular carcinoma is the sixth most prevalent cancer worldwide. Vaccination for hepatitis B and treatment of viral hepatitis are the most important preventive therapies against hepatocellular carcinoma. Recent studies have suggested that regular use of aspirin may play a role in the prevention of hepatocellular carcinoma, but its use remains controversial because of the paucity of studies. Methods: We conducted a systematic review and meta-analysis of studies that described the association between aspirin use and the incidence of hepatocellular carcinoma. We performed a comprehensive search in the databases of PubMed/MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials through Nov 16, 2020. We considered randomized controlled trials, cohort studies, and case-control studies. We excluded abstracts, animal studies, case reports, reviews, editorials, and letters to editors. Our outcomes were the incidence of hepatocellular carcinoma and major gastrointestinal bleeding during the follow-up period. The random-effects model was used to calculate the hazard ratios (HR), risk ratio (RR), and confidence intervals (CI). A P-value < 0.05 was considered statistically significant. Heterogeneity was assessed using the Higgins I2 index. Results: Twelve studies involving 2,666,799 subjects were included in the meta-analysis. Subjects were either healthy individuals or diagnosed with hepatitis (alcoholic or viral). Pooled results of the included studies showed a significant decrease in hepatocellular carcinoma in patients who received aspirin therapy compared to those who did not (HR 0.56, 95% CI 0.46-0.67, P <0.01, I2 90.92%). Three studies assessed the risk of major gastrointestinal bleeding while on aspirin therapy. Pooled results of these studies showed no significant difference in the rates of major gastrointestinal bleeding between patients who consumed aspirin and controls (RR 1.1, 95% CI 0.97-1.27, P 0.14, I2 49.47%). Conclusion: Our meta-analysis demonstrated a significant reduction in the risk of hepatocellular carcinoma in individuals who consumed aspirin. Moreover, aspirin use did not increase the risk of developing major gastrointestinal bleeding. This suggests that the daily use of aspirin can be utilized as a primary preventive strategy for hepatocellular carcinoma. However, further randomized clinical trials with a large sample size are needed before implementing any strategies.Figure 1.: Aspirin usage and risk of liver cancer.