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    Home > Active Ingredient News > Antitumor Therapy > Hong Kong study: Only low doses can reduce the risk of lung cancer and death by 1/4 in COPD patients!

    Hong Kong study: Only low doses can reduce the risk of lung cancer and death by 1/4 in COPD patients!

    • Last Update: 2022-01-23
    • Source: Internet
    • Author: User
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    Lung cancer is the most common malignancy worldwide, with an estimated incidence of 2.
    1 million cases and 1.
    8 million deaths in 2018

    .
    There are currently 1 billion smokers in the world, and they are at greater risk

    .
    In addition, chronic obstructive pulmonary disease (COPD), a progressive airway disease caused by smoking, is by far the most common comorbidity in lung cancer patients, with a prevalence of 30%-70%

    .
    Among smokers, patients with COPD had a higher risk of developing lung cancer than those without COPD, suggesting a possible shared pathogenic mechanism between the two diseases

    .
    Given the lack of curative interventions for COPD,
    prevention strategies for lung cancer in COPD patients are urgently needed
    .

    Lung Cancer Prevention

    Previous studies have shown that aspirin prevents exacerbations, reduces hospitalizations, and improves lung function and survival in patients with COPD
    .
    In addition, both experimental and clinical data suggest that aspirin prevents carcinogenesis in various systems

    .
    A recent cohort study showed that use of low-dose aspirin for more than 5 years was associated with a modest reduction in lung cancer risk

    .
    However, meta-analyses of the association between aspirin and lung cancer in the general population have conflicting results

    .
    In addition, the ability of aspirin to reduce lung cancer in COPD patients has not been specifically evaluated, and it may be more clinically relevant to assess the association between aspirin and lung cancer in this specific population

    .
    This nationwide cohort study was designed to investigate the association between aspirin use and lung cancer events and associated mortality in COPD patients

    .
    In addition, the risk of upper
    gastrointestinal
    .

    Digestion

    1.
    Participant characteristics

    Of the 89,988 COPD patients diagnosed between 2005 and 2018, 42,728 were eligible, including 35,049 aspirin nonusers and 7,679 aspirin users (Figure 1)
    .
    Baseline characteristics of the entire cohort are shown in (Table 1)

    .
    The mean age of the cohort was 75.
    7 years, and the majority were men

    .
    Patient characteristics were well balanced

    .
    Among aspirin users, 1,330 (17.
    3%) had
    vascular disease and/or coronary artery disease, and 3,198 (41.
    6%) had at least 1 cardiovascular risk factor (i.
    e.
    diabetes , obesity, hypertension ) or dyslipidemia requiring lipid-lowering drugs)
    .

    Diagnosing Vascular Diabetes Hypertension

    2.
    Lung cancer

    During a median follow-up of 2.
    6 years (interquartile range [IQR]: 1.
    4 to 4.
    8), 1,779 patients (4.
    2%) were diagnosed with lung cancer in 148,683 person-years

    .
    The median age at lung cancer diagnosis was 78.
    0 years (IQR: 71.
    8–83.
    4 years), and the median time from the index date to lung cancer diagnosis was 1.
    74 years (IQR: 0.
    79–3.
    25 years)

    .
    Among aspirin users, the 3- and 5-year cumulative incidence rates of lung cancer were 2.
    0% and 2.
    8%, respectively; among aspirin non-users, the rates were 2.
    7% and 3.
    6%, respectively (
    Figure 2 )
    .
    After multivariate adjustment, aspirin users had a 25% lower risk of lung cancer than nonusers (Table 2, SHR = 0.
    75, 95% confidence interval [CI] 0.
    65 - 0.
    87, p <
    0.
    001)

    .
    In the third and fifth years, this translates to an NNT of 143 and 125, respectively
    .

    Figure 2 After adjustment of multivariate, the risk of pulmonary cancer in aspirin is 25% lower than that of non-service users (Table 2, SHR = 0.
    75, 95% trusted section [CI] 0.
    65 - 0.
    87, P <
    0.
    001)

    .
    In the third year and fifth year, this is 143 and 125, respectively, from NNT
    .

    A total of 26,186 deaths occurred during follow-up, of which 1,694 (6.
    0%) were attributable to lung cancer

    .
    After taking non-lung cancer causes of death and lung resection as competing risks, aspirin use was associated with a 26% reduction in lung cancer-related mortality compared with non-users (SHR = 0.
    74, 95% CI 0.
    64 to 0.
    86, p<0.
    001 )

    .

    The histological classification of lung cancer was searchable and 832 cases were reported ( Table 3 )
    .
    This included 116 cases of small cell lung cancer and 716 cases of non-small cell lung cancer

    .
    Aspirin use was significantly associated with a lower odds of small cell carcinoma compared with nonusers (SHR = 0.
    53, 95% CI 0.
    30 to 0.
    95, p = 0.
    03), and there was no significant difference between aspirin users and nonusers.
    hazard cell carcinoma of no
    statistical significance difference (SHR = 0.
    84,95% CI 0.
    67 Zhi 1.
    06, the p-= 0.
    14)

    .

    Table 3 Statistics

    3.
    Subgroup analysis

    The results of the subgroup analysis are summarized in Table 4
    .
    Aspirin users versus nonusers in two groups aged >75 years or ≤75 years, male, nondiabetic, nonhypertensive, inhaled steroid users or nonusers, antimuscarinic only Drug and antimuscarinic combined beta-agonist bronchodilator users, statin non-users, and non-aspirin non-steroidal anti-inflammatory drug users were associated with a lower incidence of lung cancer
    .
    However, given the small size of some subgroups, the results should be interpreted with caution

    .
    The results of the interaction were not significant for all variables studied

    .

    Table 4
    .

    4.
    Bleeding

    From the date of the indicator date to the patient's death , 12,581 cases of bleeding diagnosis were recorded (Table 5) in 7194 patients
    .
    After adjusting age, gender, common disease, concurrent drug use and socioeconomic status agents, Poisson returns to the count ratio of aspirin tabers and non-service users (95% CI 1.
    30 - 1.
    36, P <
    0.
    001)

    .
    Only the survival functions of the first bleeding time, after multiple factors adjusted, aspirin users' SHR is 1.
    78, rather than 1.
    78 (95% CI is 1.
    68 - 1.
    89, P = 0.
    001)

    .
    Compared with non-users, aspirin is not related to UGIB,
    especially multivariate adjustments (SHR = 1.
    19, 95% Ci 0.
    94 - 1.
    53, P = 0.
    16), and the 5-year incidence is 0.
    7% and 0.
    8%, respectively

    .
    However, in a multi-factor adjustment, it is obviously related to higher hemopolicity compared to those who do not take aspirin (SHR = 1.
    96, 95% Ci 1.
    73 - 2.
    23, P
    <0.
    001)

    .
    When aspirin users have been reviewed by other antiplatelets, aspirin has weakened the risk of overall bleeding, UGIB and hemopatum, while maintaining statistical significance (
    S7 table )
    .
    The uncomfortable results are shown in Table 5 and S7 tables
    .
    Since Aspirin is likely to stop the drug during bleeding, we have sensitively analyzed the relationship between aspirin and lung cancer.
    At the same time, it is an additional competitive risk.
    In this case, aspirin is compared with non-use.
    The use of lung cancer is reduced by 30% (SHR 0.
    70, 95% Ci 0.
    60 to 0.
    82, 
    p  < 0.
    001)

    .

    From index date to patient death A total of 12,581 bleeding diagnoses were recorded among 7,194 patients (Table 5)
    .
    After adjusting for proxies for age, sex, comorbidities, concurrent drug use, and socioeconomic status, Poisson regression yielded a count ratio of aspirin users to nonusers of 1.
    33 (95% CI 1.
    30 - 1.
    36, p<
    0.
    001)

    .
    After adjusting for proxies for age, sex, comorbidities, concurrent drug use, and socioeconomic status, Poisson regression yielded a count ratio of aspirin users to nonusers of 1.
    33 (95% CI 1.
    30 - 1.
    36, p<
    0.
    001)

    .
    After multivariate adjustment, the SHR was 1.
    78 for aspirin users and 1.
    78 for non-users (95% CI 1.
    68 - 1.
    89, p = 0.
    001),
    especially after multivariate adjustment (SHR = 1.
    19, 95% CI 0.
    94 - 1.
    53 , p = 0.
    16), and the 5-year incidence rates were 0.
    7% and 0.
    8%, respectively

    .
    However, in multivariate adjustment, those who took aspirin were significantly associated with a higher risk of hemoptysis compared to those who did not take aspirin (SHR = 1.
    96, 95% CI 1.
    73 - 2.
    23, p
    S7 Table for unadjusted results in table 5 and S7 tables
    .
    p

    Taken together, aspirin use was associated with a 25% reduction in lung cancer risk (SHR = 0.
    75, 95% confidence interval [CI] 0.
    65 to 0.
    87, p 
    = <0.
    001) and a 26% reduction in lung cancer-related mortality (SHR = 0.
    74) , 95%CI 0.
    64 to 0.
    86, p = <0.
    001)

    .
    Subgroup analyses showed that aspirin was beneficial in patients over 75 years of age and in men, non-diabetic and non-hypertensive populations
    .
    Aspirin use was not associated with an increased risk of upper
    gastrointestinal
    = 0.
    16), but was associated with an increased risk of hemoptysis (SHR = 1.
    96, 95% CI 1.
    73 to 2.
    23, p <0.
    001)

    .
    Aspirin may serve as a potential preventive treatment for lung cancer in COPD patients, but the increased risk of adverse effects warrants further evaluation
    .
    Although the current retrospective study should not be considered sufficient evidence to include aspirin in COPD management strategies, the protective association between aspirin and lung cancer deserves to be elucidated through future randomized studies to thoroughly investigate its benefits and associated adverse effects, To enable rigorous cost-benefit analysis and improve patient autonomy in clinical decision-making
    .

    Aspirin use was associated with a 25% reduction in lung cancer risk (SHR = 0.
    75, 95% confidence interval [CI] 0.
    65 to 0.
    87, p 
    = <0.
    001) and a 26% reduction in lung cancer-related mortality (SHR = 0.
    74, 95%) CI 0.
    64 to 0.
    86, p = < 0.
    001)

    .
    Subgroup analyses showed that aspirin was beneficial in patients over 75 years of age and in men, non-diabetic and non-hypertensive populations
    .
    Aspirin use was not associated with an increased risk of upper
    gastrointestinal
    digest = 0.
    16), but was associated with an increased risk of hemoptysis (SHR = 1.
    96, 95% CI 1.
    73 to 2.
    23, p < 0.
    001)

    .
    Although the current retrospective study should not be considered sufficient evidence to include aspirin in COPD management strategies, the protective association between aspirin and lung cancer deserves to be elucidated through future randomized studies to thoroughly investigate its benefits and associated adverse effects, To enable rigorous cost-benefit analysis and improve patient autonomy in clinical decision-making
    .
    manage

     

    Original source:

    Si-Yeung Yu ,et al.
    Low-dose aspirin and incidence of lung carcinoma in patients with chronic obstructive pulmonary disease in Hong Kong: A cohort study.

    Si-Yeung Yu

    PLOS Medicine | https://doi.
    org/10.
    1371/journal.
    pmed.
    1003880 January 13, 2022



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