Koji Matsuo1, Sigita S Cahoon, Kosuke Yoshihara, Masako Shida, Mamoru Kakuda, Sosuke Adachi, Aida Moeini, Hiroko Machida, Jocelyn Garcia-Sayre, Yutaka Ueda, Takayuki Enomoto, Mikio Mikami, Lynda D Roman, Anil K Sood. 1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, and the Norris Comprehensive Cancer Center, Los Angeles, California; the Departments of Obstetrics and Gynecology, Tokai University School of Medicine, Kanagawa, Osaka University Graduate School of Medicine, Osaka, and Niigata University Graduate School of Medicine, Niigata, Japan; and the Departments of Gynecologic Oncology and Cancer Biology and the Center for RNA Interference and Non-Coding RNAs, the University of Texas MD Anderson Cancer Center, Houston, Texas.
Abstract
OBJECTIVE: To examine the survival outcomes in women with endometrial cancer who were taking low-dose aspirin (81-100 mg/d). METHODS: A multicenter retrospective study was conducted examining patients with stage I-IV endometrial cancer who underwent hysterectomy-based surgical staging between January 2000 and December 2013 (N=1,687). Patient demographics, medical comorbidities, medication types, tumor characteristics, and treatment patterns were correlated to survival outcomes. A Cox proportional hazard regression model was used to estimate adjusted hazard ratio for disease-free and disease-specific overall survival. RESULTS: One hundred fifty-eight patients (9.4%, 95% confidence interval [CI] 8.8-11.9) were taking low-dose aspirin. Median follow-up time for the study cohort was 31.5 months. One hundred twenty-seven patients (7.5%) died of endometrial cancer. Low-dose aspirin use was significantly correlated with concurrent obesity, hypertension, diabetes mellitus, and hypercholesterolemia (all P<.001). Low-dose aspirin users were more likely to take other antihypertensive, antiglycemic, and anticholesterol agents (all P<.05). Low-dose aspirin use was not associated with histologic subtype, tumor grade, nodal metastasis, or cancer stage (all P>.05). On multivariable analysis, low-dose aspirin use remained an independent prognostic factor associated with an improved 5-year disease-free survival rate (90.6% compared with 80.9%, adjusted hazard ratio 0.46, 95% CI 0.25-0.86, P=.014) and disease-specific overall survival rate (96.4% compared with 87.3%, adjusted hazard ratio 0.23, 95% CI 0.08-0.64, P=.005). The increased survival effect noted with low-dose aspirin use was greatest in patients whose age was younger than 60 years (5-year disease-free survival rates, 93.9% compared with 84.0%, P=.013), body mass index was 30 or greater (92.2% compared with 81.4%, P=.027), who had type I cancer (96.5% compared with 88.6%, P=.029), and who received postoperative whole pelvic radiotherapy (88.2% compared with 61.5%, P=.014). These four factors remained significant for disease-specific overall survival (all P<.05). CONCLUSION: Our results suggest that low-dose aspirin use is associated with improved survival outcomes in women with endometrial cancer, especially in those who are young, obese, with low-grade disease, and who receive postoperative radiotherapy.
OBJECTIVE: To examine the survival outcomes in women with endometrial cancer who were taking low-dose aspirin (81-100 mg/d). METHODS: A multicenter retrospective study was conducted examining patients with stage I-IV endometrial cancer who underwent hysterectomy-based surgical staging between January 2000 and December 2013 (N=1,687). Patient demographics, medical comorbidities, medication types, tumor characteristics, and treatment patterns were correlated to survival outcomes. A Cox proportional hazard regression model was used to estimate adjusted hazard ratio for disease-free and disease-specific overall survival. RESULTS: One hundred fifty-eight patients (9.4%, 95% confidence interval [CI] 8.8-11.9) were taking low-dose aspirin. Median follow-up time for the study cohort was 31.5 months. One hundred twenty-seven patients (7.5%) died of endometrial cancer. Low-dose aspirin use was significantly correlated with concurrent obesity, hypertension, diabetes mellitus, and hypercholesterolemia (all P<.001). Low-dose aspirin users were more likely to take other antihypertensive, antiglycemic, and anticholesterol agents (all P<.05). Low-dose aspirin use was not associated with histologic subtype, tumor grade, nodal metastasis, or cancer stage (all P>.05). On multivariable analysis, low-dose aspirin use remained an independent prognostic factor associated with an improved 5-year disease-free survival rate (90.6% compared with 80.9%, adjusted hazard ratio 0.46, 95% CI 0.25-0.86, P=.014) and disease-specific overall survival rate (96.4% compared with 87.3%, adjusted hazard ratio 0.23, 95% CI 0.08-0.64, P=.005). The increased survival effect noted with low-dose aspirin use was greatest in patients whose age was younger than 60 years (5-year disease-free survival rates, 93.9% compared with 84.0%, P=.013), body mass index was 30 or greater (92.2% compared with 81.4%, P=.027), who had type I cancer (96.5% compared with 88.6%, P=.029), and who received postoperative whole pelvic radiotherapy (88.2% compared with 61.5%, P=.014). These four factors remained significant for disease-specific overall survival (all P<.05). CONCLUSION: Our results suggest that low-dose aspirin use is associated with improved survival outcomes in women with endometrial cancer, especially in those who are young, obese, with low-grade disease, and who receive postoperative radiotherapy.
Authors: Theodore M Brasky; Ashley S Felix; David E Cohn; D Scott McMeekin; David G Mutch; William T Creasman; Premal H Thaker; Joan L Walker; Richard G Moore; Shashikant B Lele; Saketh R Guntupalli; Levi S Downs; Christa I Nagel; John F Boggess; Michael L Pearl; Olga B Ioffe; Kay J Park; Shamshad Ali; Louise A Brinton Journal: J Natl Cancer Inst Date: 2017-03-01 Impact factor: 13.506
Authors: Omolara B Sanni; Úna C Mc Menamin; Chris R Cardwell; Linda Sharp; Liam J Murray; Helen G Coleman Journal: Br J Cancer Date: 2017-07-06 Impact factor: 7.640
Authors: Peter C Elwood; Janet E Pickering; Gareth Morgan; Julieta Galante; Alison L Weightman; Delyth Morris; Marcus Longley; Malcolm Mason; Richard Adams; Sunil Dolwani; John Chia W K; Angel Lanas Journal: PLoS One Date: 2018-09-25 Impact factor: 3.240