Plos One:阿司匹林或可降低癌症患者死亡率及转移率
医脉通 · 2016/04/22
近期发表在 PLOS ONE 上的研究考察了癌症治疗中低剂量阿司匹林的作用。研究人员回顾了47项相关研究的数据,结果显示结直肠癌、乳腺癌和前列腺癌的治疗过程中服用低剂量阿司匹林的患者,死亡率降低了15-20%,转移发生率也有所降低。

近期发表在 PLOS ONE 上的研究考察了癌症治疗中低剂量阿司匹林的作用。研究人员回顾了47项相关研究的数据,结果显示结直肠癌、乳腺癌和前列腺癌的治疗过程中服用低剂量阿司匹林的患者,死亡率降低了15-20%,转移发生率也有所降低。


这项研究来自于 Cardiff 大学医学院教授 Peter Elwood 博士团队。研究人员通过对已发表的研究进行系统性审查发现,患者在癌症治疗方案中加入低剂量阿司匹林显著降低了死亡率和癌症转移率(研究的平均随访时间超过5年)。

“越来越多的证据显示服用阿司匹林显著降低了一些癌症的发生,然而尚不明确阿司匹林在癌症治疗中是否具有类似作用。因此我们对所有已发表的研究进行了系统性调查研究”,Elwood 介绍道。


Elwood 教授表示:“基于目前所有可获得的证据,我们的研究显示肠癌、乳腺癌或前列腺癌患者在治疗方案中加入低剂量阿司匹林,与死亡率降低15-20%相关,同时也与转移率降低相关。

“来自其它癌种的6项研究结果也提示存在类似的降低,但是由于患者数量过少,不能得出令人信服的结论。大约20%患者携带 PIK3CA 突变,或许能够解释阿司匹林降低结肠癌死亡率的原因。


作为这项研究的结论,研究团队强调了需要随机对照试验以明确这些证据,以支持在癌症治疗中额外加入低剂量阿司匹林。“现在迫切需要有更多的研究细节支持我们的结论,包括在不那么常见的癌症领域的证据。我们鼓励癌症患者确诊时与医生交流我们的研究结果,从而进行知情决策,以确定是否需要在治疗方案中加入低剂量阿司匹林”, Elwood 教授补充道。

  • Aspirin in the Treatment of Cancer: Reductions in Metastatic Spread and in Mortality: A Systematic Review and Meta-Analyses of Published Studies

    Background Low-dose aspirin has been shown to reduce the incidence of cancer, but its role in the treatment of cancer is uncertain. Objectives We conducted a systematic search of the scientific literature on aspirin taken by patients following a diagnosis of cancer, together with appropriate meta-analyses. Methods Searches were completed in Medline and Embase in December 2015 using a pre-defined search strategy. References and abstracts of all the selected papers were scanned and expert colleagues were contacted for additional studies. Two reviewers applied pre-determined eligibility criteria (cross-sectional, cohort and controlled studies, and aspirin taken after a diagnosis of cancer), assessed study quality and extracted data on cancer cause-specific deaths, overall mortality and incidence of metastases. Random effects meta-analyses and planned sub-group analyses were completed separately for observational and experimental studies. Heterogeneity and publication bias were assessed in sensitivity analyses and appropriate omissions made. Papers were examined for any reference to bleeding and authors of the papers were contacted and questioned. Results Five reports of randomised trials were identified, together with forty two observational studies: sixteen on colorectal cancer, ten on breast and ten on prostate cancer mortality. Pooling of eleven observational reports of the effect of aspirin on cause-specific mortality from colon cancer, after the omission of one report identified on the basis of sensitivity analyses, gave a hazard ratio (HR) of 0.76 (95% CI 0.66, 0.88) with reduced heterogeneity (P = 0.04). The cause specific mortality in five reports of patients with breast cancer showed significant heterogeneity (P<0.0005) but the omission of one outlying study reduced heterogeneity (P = 0.19) and led to an HR = 0.87 (95% CI 0.69, 1.09). Heterogeneity between nine studies of prostate cancer was significant, but again, the omission of one study led to acceptable homogeneity (P = 0.26) and an overall HR = 0.89 (95% CI 0.79–0.99). Six single studies of other cancers suggested reductions in cause specific mortality by aspirin, and in five the effect is statistically significant. There were no significant differences between the pooled HRs for the three main cancers and after the omission of three reports already identified in sensitivity analyses heterogeneity was removed and revealed an overall HR of 0.83 (95% CI 0.76–0.90). A mutation of PIK3CA was present in about 20% of patients, and appeared to explain most of the reduction in colon cancer mortality by aspirin. Data were not adequate to examine the importance of this or any other marker in the effect of aspirin in the other cancers. On bleeding attributable to aspirin two reports stated that there had been no side effect or bleeding attributable to aspirin. Authors on the other reports were written to and 21 replied stating that no data on bleeding were available. Conclusions and Implications The study highlights the need for randomised trials of aspirin treatment in a variety of cancers. While these are awaited there is an urgent need for evidence from observational studies of aspirin and the less common cancers, and for more evidence of the relevance of possible bio-markers of the aspirin effect on a wide variety of cancers. In the meantime it is urged that patients in whom a cancer is diagnosed should be given details of this research, together with its limitations, to enable each to make an informed decision as to whether or not to take low-dose aspirin.

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