Junya Arai1, Ryota Niikura2,3, Yoku Hayakawa2, Takuya Kawahara4, Tetsuro Honda5, Kenkei Hasatani6, Naohiro Yoshida7, Tsutomu Nishida8, Tetsuya Sumiyoshi9, Shu Kiyotoki10, Takashi Ikeya11, Masahiro Arai12, Nobumi Suzuki2, Yosuke Tsuji2, Atsuo Yamada2, Takashi Kawai3, Kazuhiko Koike2. 1. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan, ayayadejunya@yahoo.co.jp. 2. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 3. Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan. 4. Clinical Research Promotion Center, The University of Tokyo Hospital, Tokyo, Japan. 5. Department of Gastroenterology, Nagasaki Harbor Medical Center, Nagasaki, Japan. 6. Department of Gastroenterology, Fukui Prefectural Hospital, Fukui, Japan. 7. Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa-shi, Japan. 8. Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka, Japan. 9. Department of Gastroenterology, Tonan Hospital, Sapporo-shi, Japan. 10. Department of Gastroenterology, Shuto General Hospital, Yamaguchi, Japan. 11. Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan. 12. Department of Gastroenterology, Nerima Hikarigaoka Hospital, Tokyo, Japan.
Abstract
BACKGROUND: Oesophageal cancer comprises 2 different histological variants: oesophageal squamous-cell carcinoma (ESCC) and adenocarcinoma (EAC). While there are multiple therapeutic options for both types, patients with advanced or metastatic oesophageal cancer still suffer from poor prognosis. AIMS: The study aimed to examine the association between the risk of oesophageal cancer and medications and to estimate the chemopreventive effects of commonly used drugs. METHODS: A multicentre retrospective cohort study was conducted using data from 9 hospital databases of hospitalized patients between 2014 and 2019. The primary outcomes were ESCC and EAC. The association of oesophageal cancer with drug use and clinical factors was evaluated. Odds ratios (ORs) were adjusted for age, sex, Charlson comorbidity index scores, and smoking with/without gastro-oesophageal reflux disease. RESULTS: The use of proton pump inhibitors (PPIs) (adjusted OR [aOR] 0.48, p < 0.0001), aspirin (aOR 0.32, p < 0.0001), cyclooxygenase-2 inhibitor (COX2I) (aOR 0.70, p = 0.0005), steroid (aOR 0.19, p < 0.0001), statin (aOR 0.43, p < 0.0001), and metformin (aOR 0.42, p < 0.0001) was associated with a lower risk of ESCC than that in non-use. The use of aspirin (aOR 0.33, p = 0.0006) and steroids (aOR 0.54, p = 0.022) was associated with a lower risk of EAC than that in non-use. CONCLUSION: COX2Is, statins, metformin, and PPIs could help in prevention of ESCC, and aspirin and steroids may be chemopreventive for both types of oesophageal cancer.
BACKGROUND: Oesophageal cancer comprises 2 different histological variants: oesophageal squamous-cell carcinoma (ESCC) and adenocarcinoma (EAC). While there are multiple therapeutic options for both types, patients with advanced or metastatic oesophageal cancer still suffer from poor prognosis. AIMS: The study aimed to examine the association between the risk of oesophageal cancer and medications and to estimate the chemopreventive effects of commonly used drugs. METHODS: A multicentre retrospective cohort study was conducted using data from 9 hospital databases of hospitalized patients between 2014 and 2019. The primary outcomes were ESCC and EAC. The association of oesophageal cancer with drug use and clinical factors was evaluated. Odds ratios (ORs) were adjusted for age, sex, Charlson comorbidity index scores, and smoking with/without gastro-oesophageal reflux disease. RESULTS: The use of proton pump inhibitors (PPIs) (adjusted OR [aOR] 0.48, p < 0.0001), aspirin (aOR 0.32, p < 0.0001), cyclooxygenase-2 inhibitor (COX2I) (aOR 0.70, p = 0.0005), steroid (aOR 0.19, p < 0.0001), statin (aOR 0.43, p < 0.0001), and metformin (aOR 0.42, p < 0.0001) was associated with a lower risk of ESCC than that in non-use. The use of aspirin (aOR 0.33, p = 0.0006) and steroids (aOR 0.54, p = 0.022) was associated with a lower risk of EAC than that in non-use. CONCLUSION: COX2Is, statins, metformin, and PPIs could help in prevention of ESCC, and aspirin and steroids may be chemopreventive for both types of oesophageal cancer.
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