每日服用一片阿司匹林可将癌症死亡率降低25%

香奈儿

来源 FT中文网 2010-12-7 18:27:42

Lancet：每日服用一片阿司匹林可将癌症死亡率降低25%
今日发表的研究报告表明，每日服用一片阿司匹林可将癌症死亡率降低25%。


这份发表在英国医学杂志《柳叶刀》(Lancet)上、针对25570名病人的研究表明，5年来坚持每天服用小剂量阿司匹林的所有类型的癌症病人长期死亡率有所下降。

英国东英吉利大学(University of East Anglia)转化医学教授阿拉斯泰尔?沃森(Alastair Watson)表示，最新研究“进一步证明，阿司匹林是世界上遥遥领先的最神奇的药物”。

每日服用阿司匹林，使得结直肠癌死亡率降低40%，食道癌死亡率降低60%。

19世纪末，德国拜耳公司(Bayer)合成出阿司匹林并将其大规模推向市场，标志着现代药物的问世。许多专家相信，制药业的首只药物从未被超越。

由牛津大学(Oxford university)的彼得?罗斯维尔(Peter Rothwell)牵头进行的此项研究，以8项旨在评估阿司匹林在预防心血管疾病方面效用的临床实验的数据为基础，此前这被视为阿司匹林的主要效用。研究人员审议了参与者长达20年的病历，聚焦于癌症。

卡地夫大学(Cardiff University)的彼得?埃尔伍德(Peter Elwood)表示，阿司匹林对成年人的主要副作用是加大了胃岀血的风险，但这只影响2000人中的一人，小剂量服用几乎从不致命。埃尔伍德研究阿司匹林将近40年。

4年来坚持服用小剂量阿司匹林的罗斯维尔认为，这些结果表明，总的来说，几乎所有中年人每日服用小剂量（每日服用75毫克，阿司匹林用于止痛的剂量为300毫克）阿司匹林都将受益。

罗斯维尔表示：“这些新结果并不意味着，所有成年人应该立即开始服用阿司匹林，但它们确实证明了阿司匹林新的重大效用，而早先的指导建议中未曾计入这些效用。”

埃尔伍德表示，阿司匹林可能增强细胞对DNA损伤的修复能力，从而帮助预防癌症。

尽管拜耳仍保留阿司匹林业务，但在一战后，该公司在全球许多国家丧失了阿司匹林的商标权，包括美国和英国。

行业机构——阿司匹林基金会(Aspirin Foundation)的尼克?亨德森(Nick Henderson)表示：“没有人愿意给出阿司匹林市场规模的数据，因为仿制的阿司匹林太多了，尤其是在中国。”（生物谷Bioon.com）

生物谷推荐原文出处：

The Lancet  doi:10.1016/S0140-6736(10)62110-1

Effect of daily aspirin on long-term risk of death due to cancer: analysis of individual patient data from randomised trials

Original TextProf Peter M Rothwell FMedSci a , Prof F Gerald R Fowkes FRCPE b, Prof Jill FF Belch FRCP c, Hisao Ogawa MD d, Prof Charles P Warlow FMedSci e, Prof Tom W Meade FRS f

Summary

Background

Treatment with daily aspirin for 5 years or longer reduces subsequent risk of colorectal cancer. Several lines of evidence suggest that aspirin might also reduce risk of other cancers, particularly of the gastrointestinal tract, but proof in man is lacking. We studied deaths due to cancer during and after randomised trials of daily aspirin versus control done originally for prevention of vascular events.

Methods

We used individual patient data from all randomised trials of daily aspirin versus no aspirin with mean duration of scheduled trial treatment of 4 years or longer to determine the effect of allocation to aspirin on risk of cancer death in relation to scheduled duration of trial treatment for gastrointestinal and non-gastrointestinal cancers. In three large UK trials, long-term post-trial follow-up of individual patients was obtained from death certificates and cancer registries.

Results

In eight eligible trials (25 570 patients, 674 cancer deaths), allocation to aspirin reduced death due to cancer (pooled odds ratio [OR] 0·79, 95% CI 0·68—0·92, p=0·003). On analysis of individual patient data, which were available from seven trials (23 535 patients, 657 cancer deaths), benefit was apparent only after 5 years' follow-up (all cancers, hazard ratio [HR] 0·66, 0·50—0·87; gastrointestinal cancers, 0·46, 0·27—0·77; both p=0·003). The 20-year risk of cancer death (1634 deaths in 12 659 patients in three trials) remained lower in the aspirin groups than in the control groups (all solid cancers, HR 0·80, 0·72—0·88, p<0·0001; gastrointestinal cancers, 0·65, 0·54—0·78, p<0·0001), and benefit increased (interaction p=0·01) with scheduled duration of trial treatment (≥7·5 years: all solid cancers, 0·69, 0·54—0·88, p=0·003; gastrointestinal cancers, 0·41, 0·26—0·66, p=0·0001). The latent period before an effect on deaths was about 5 years for oesophageal, pancreatic, brain, and lung cancer, but was more delayed for stomach, colorectal, and prostate cancer. For lung and oesophageal cancer, benefit was confined to adenocarcinomas, and the overall effect on 20-year risk of cancer death was greatest for adenocarcinomas (HR 0·66, 0·56—0·77, p<0·0001). Benefit was unrelated to aspirin dose (75 mg upwards), sex, or smoking, but increased with age—the absolute reduction in 20-year risk of cancer death reaching 7·08% (2·42—11·74) at age 65 years and older.

Interpretation

Daily aspirin reduced deaths due to several common cancers during and after the trials. Benefit increased with duration of treatment and was consistent across the different study populations. These findings have implications for guidelines on use of aspirin and for understanding of carcinogenesis and its susceptibility to drug intervention.