Abstract
Aim: To explore the relationship between the use of aspirin and the incidence of hepatocellular carcinoma (HCC). Methods: MEDLINE, EMBASE, Web of Science and Cochrane CENTRAL databases were searched systematically from the earliest available date to 13 March 2020. The primary outcome was incidence of HCC, and the secondary outcomes were recurrence and mortality of HCC. The results were expressed as the Hazard Ratio (HR) and 95% confidence interval (CI). Based on the heterogeneity evaluated with the I 2 statistic, a meta-analysis was performed using either a random- or fixed-effects model. Results: A total of sixteen articles (2781100 participants) were included. There was lower incidence of HCC in aspirin users than those in non-aspirin users (HR, 0.56; 95% CI, 0.46-0.69; p < 0.001). Subgroup analysis further showed that the incidence of liver cancer in patients with alcoholic cirrhosis (HR, 0.14; 95% CI, 0.09-0.22; p < 0.001) and virus hepatitis (HR, 0.68; 95% CI, 0.62-0.74; p < 0.001) who use aspirin was lower than that of patients who do not use aspirin. In addition, aspirin was found to associate with decreased risk of HCC mortality (HR, 0.71; 95% CI, 0.65-0.78; p < 0.001), not HCC recurrence (HR, 0.52; 95% CI, 0.15-1.76; p = 0.291). Conclusions: Aspirin use is significantly associated with the low incidence rate of liver cancer.
Highlights
Hepatocellular carcinoma (HCC) accounts for a large proportion of cancer deaths worldwide ((Torre et al, 2015; Bray et al, 2018)), and the incidence of HCC is predicted to increase in the future ((Torre et al, 2015; Bray et al, 2018))
Subgroup analysis further showed that the incidence of liver cancer in patients with alcoholic cirrhosis (HR, 0.14; 95% confidence interval (CI), 0.09-0.22; p < 0.001) and virus hepatitis (HR, 0.68; 95% CI, 0.62-0.74; p < 0.001) who use aspirin was lower than that of patients who do not use aspirin
Twelve articles reported the relationship between aspirin and incidence of HCC((Sahasrabuddhe et al, 2012; Petrick et al, 2015; Yang et al, 2016; Hwang et al, 2018), (Sahasrabuddhe et al, 2012; Petrick et al, 2015; Yang et al, 2016; Hwang et al, 2018), (Simon et al, 2018; Du et al, 2019; Lee et al, 2019; Tsoi et al, 2019; Liao et al, 2020; Shin et al, 2020; Simon et al, 2020)), two articles showed the relation between aspirin and recurrence of HCC((Yeh et al, 2015; Young et al, 2020)), and five articles indicated the connection between aspirin and mortality of HCC((Jacobs et al, 2012; Li et al, 2016; Du et al, 2019; Simon et al, 2020; Young et al, 2020))
Summary
Hepatocellular carcinoma (HCC) accounts for a large proportion of cancer deaths worldwide ((Torre et al, 2015; Bray et al, 2018)), and the incidence of HCC is predicted to increase in the future ((Torre et al, 2015; Bray et al, 2018)). HCC can grow at an exponential rate; its recurrence can occur after a therapy and its subsequent metastasis can lead to mortality, making it the second cause of death of cancer patients ((Torre et al, 2015; Bray et al, 2018)). The current diagnosis of HCC remains ineffective; it is important that preventive methods are developed ((Torre et al, 2015; Bray et al, 2018)). The main risk factors for HCC are chronic hepatitis and virus infection, in particular hepatitis. Several studies have suggested that chronic hepatitis inflammation could induce HCC((Raza et al, 2011; Hossain et al, 2012; Li et al, 2013a)), especially occurring through the cyclooxygenase-2 (COX-2) pathway ((Cheng et al, 2004)). Modulation of the inflammatory pathways may become a novel method that can restrict HCC development
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