Pei-Chang Lee1,2,3, Chiu-Mei Yeh4, Yu-Wen Hu2,5,6, Chun-Chia Chen2,7, Chia-Jen Liu8,9,10, Chien-Wei Su11,12, Teh-Ia Huo1,7, Yi-Hsiang Huang7,13, Yee Chao2,5, Tzeng-Ji Chen2,14, Han-Chieh Lin2,7, Jaw-Ching Wu13,15. 1. Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan. 2. Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan. 3. Division of Gastroenterology and Hepatology, Department of Medicine, Yuanshan Branch, Taipei Veterans General Hospital, Yilan, Taiwan. 4. Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. 5. Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan. 6. Institute of Public Health, National Yang-Ming University, Taipei, Taiwan. 7. Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. 8. Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan. chiajenliu@gmail.com. 9. Institute of Public Health, National Yang-Ming University, Taipei, Taiwan. chiajenliu@gmail.com. 10. Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. chiajenliu@gmail.com. 11. Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan. cwsu2@vghtpe.gov.tw. 12. Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. cwsu2@vghtpe.gov.tw. 13. Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan. 14. Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan. 15. Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan.
Abstract
BACKGROUND: Recurrence of hepatocellular carcinoma (HCC) with unsatisfactory survival is common after surgical resection. Antiplatelet therapy with aspirin or clopidogrel was recently shown to prevent hepatic carcinogenesis in a murine model, but its effect in humans had not been clarified. This study aimed to investigate the association between antiplatelet therapy and the outcomes for patients with hepatitis B virus (HBV)-related HCC after liver resection. METHODS: By analyzing data from the Taiwan National Health Insurance Research Database, 9461 HBV-related HCC patients who had undergone liver resection between January 1997 and December 2011 were identified. After one-to-four matching by sex, age, and propensity score, 442 patients with antiplatelet therapy and 1768 patients without antiplatelet therapy were enrolled for the analysis. The Kaplan-Meier method and modified Cox proportional hazards models were used for survival and multivariable, stratified analyses. RESULTS: Recurrence-free survival and overall survival after resection surgery were significantly better after 5 years in the treated cohort than in the untreated cohort (52.8 vs 47.9 %; p = 0.021 and 80.3 vs 65.4 %; p < 0.001, respectively). Besides, antiplatelet therapy reduced the risk of HCC recurrence (hazard ratio [HR] 0.73; p < 0.001) and overall mortality (HR 0.57; p < 0.001) in the multivariable analysis. However, antiplatelet use significantly increased the risk of upper gastrointestinal bleeding (odds ratio [OR] 1.91; p < 0.001). CONCLUSIONS: Use of aspirin or clopidogrel was associated with better recurrence-free survival and overall survival among patients with HBV-related HCC after liver resection. However, these agents should be used with caution due to the adverse effects of upper gastrointestinal bleeding.
BACKGROUND: Recurrence of hepatocellular carcinoma (HCC) with unsatisfactory survival is common after surgical resection. Antiplatelet therapy with aspirin or clopidogrel was recently shown to prevent hepatic carcinogenesis in a murine model, but its effect in humans had not been clarified. This study aimed to investigate the association between antiplatelet therapy and the outcomes for patients with hepatitis B virus (HBV)-related HCC after liver resection. METHODS: By analyzing data from the Taiwan National Health Insurance Research Database, 9461 HBV-related HCC patients who had undergone liver resection between January 1997 and December 2011 were identified. After one-to-four matching by sex, age, and propensity score, 442 patients with antiplatelet therapy and 1768 patients without antiplatelet therapy were enrolled for the analysis. The Kaplan-Meier method and modified Cox proportional hazards models were used for survival and multivariable, stratified analyses. RESULTS: Recurrence-free survival and overall survival after resection surgery were significantly better after 5 years in the treated cohort than in the untreated cohort (52.8 vs 47.9 %; p = 0.021 and 80.3 vs 65.4 %; p < 0.001, respectively). Besides, antiplatelet therapy reduced the risk of HCC recurrence (hazard ratio [HR] 0.73; p < 0.001) and overall mortality (HR 0.57; p < 0.001) in the multivariable analysis. However, antiplatelet use significantly increased the risk of upper gastrointestinal bleeding (odds ratio [OR] 1.91; p < 0.001). CONCLUSIONS: Use of aspirin or clopidogrel was associated with better recurrence-free survival and overall survival among patients with HBV-related HCC after liver resection. However, these agents should be used with caution due to the adverse effects of upper gastrointestinal bleeding.
Authors: Han Ah Lee; Young Chang; Pil Soo Sung; Eileen L Yoon; Hye Won Lee; Jeong-Ju Yoo; Young-Sun Lee; Jihyun An; Do Seon Song; Young Youn Cho; Seung Up Kim; Yoon Jun Kim Journal: Clin Mol Hepatol Date: 2022-07-01
Authors: Marek Z Wojtukiewicz; Dominika Hempel; Ewa Sierko; Stephanie C Tucker; Kenneth V Honn Journal: Cancer Metastasis Rev Date: 2017-06 Impact factor: 9.264