Gastric adenocarcinoma

Studies have shown that the use of low-dose aspirin may reduce cancer incidence rate and mortality, but its impact on the survival of gastric adenocarcinoma is not clear. Foreign teams have carried out relevant studies to evaluate whether taking aspirin after gastrectomy for gastric adenocarcinoma can improve long-term survival. The results were published in the journal gastric cancer.

This population-based cohort study included patients who underwent gastrectomy for gastric adenocarcinoma in Sweden from 2006 to 2015 and were followed up throughout 2020. Exposure to low daily doses (75-160 mg) of aspirin 1, 2, 3 years before surgery and 1 year after gastrectomy was associated with 5-year all-cause mortality (primary outcome) and disease-specific mortality. Multivariable Cox regression analysis provided a 95% confidence interval (CI) hazard ratio (HR), adjusted for age, gender, education, years, comorbidity, statin use, tumor location, tumor staging, neoadjuvant chemotherapy, the number of surgeons for gastrectomy, and radical surgery.

The study included 2025 patients, of whom 545 (26.9%) used aspirin during surgery. Among the patients taking aspirin, 178 (32.7%) did not take aspirin again after operation. About 56 patients (2.8%) began to use aspirin within one year after gastrectomy. 52 (9.5%) aspirin users and 91 (6.2%) non aspirin users died within 90 days of surgery.

The Kaplan Meier curve showed that there was no significant difference in survival between patients with and without aspirin.

Aspirin use within 1 year before surgery did not reduce the adjusted risk of 5-year all-cause mortality (HR = 0.98, 95% CI 0.85-1.13) or disease-specific mortality (HR = 1.00, 95% CI 0.86-1.17).

Taking aspirin within 2 years (HR = 0.98, 95% CI 0.84-1.15) or 3 years (HR = 0.94, 95% CI 0.79-1.12) before surgery did not reduce the risk of 5-year all-cause mortality. Similarly, there was no reduction in the 5-year risk of all-cause death in patients who used aspirin before and 1 year after surgery (adjusted hr=1.01, 95% CI 0.82-1.25).

In the sensitivity analysis, we excluded 291 patients (14.3%) with gastrectomy without definite treatment purpose. In the analysis of 1734 patients, the 90 day mortality rate was 4.0%. Aspirin use was not associated with 5-year all-cause mortality (adjusted hr=0.92, 95% CI 0.78-1.09) or 5-year disease-specific mortality (adjusted hr=0.94, 95% CI 0.79-1.13) compared with non aspirin users.

In conclusion, studies have shown that the use of low-dose aspirin may not improve the long-term survival rate after gastric adenocarcinoma surgery.

Original source: Holmberg D, Kauppila JH, Mattsson F, Asplund J, Leijonmarck W, Xie SH, Lagergren J. Aspirin use in relation to long-term survival after gastrectomy for gastric adenocarcinoma. Gastric Cancer. 2022 Feb 15. doi: 10.1007/s10120-022-01282-0. Epub ahead of print. PMID: 35166957.

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