Jin Lin Tan1, Sandeep Sidhu-Brar2, Richard Woodman3, Mohamed Asif Chinnaratha4,5. 1. Division of Medicine, Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, SA, 5112, Australia. jin.tan@sa.gov.au. 2. Division of Medicine, Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, SA, 5112, Australia. 3. Flinders Centre for Epidemiology and Biostatistics, Flinders University, Sturt Rd, Bedford Park, SA, 5042, Australia. 4. Department of Gastroenterology/Hepatology, Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, SA, 5112, Australia. 5. Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, 5005, Australia.
Abstract
PURPOSE: Aspirin reduces the incidence of various gastrointestinal (GI) malignancies. This meta-analysis assessed the efficacy and safety of regular aspirin use on the incidence of hepatocellular carcinoma (HCC) in patients with chronic liver disease. METHODS: Electronic reference databases were searched for studies in patients with chronic liver disease exposed to aspirin. The primary outcome was the incidence of HCC in regular aspirin users compared to non-users. The secondary outcome was the incidence of major GI bleeding events in both groups. The propensity score (PS) and non-PS-adjusted pooled hazard ratio (HR) were calculated using random-effects models. RESULTS: Six observational studies with 71,211 subjects were included. The median duration of follow-up ranged from 2.7 to 7.9 years. Four studies included patients with viral hepatitis; five studies used aspirin 100 mg/day. All six studies reported the non-PS-matched HR, and there was a 54% reduction in the incidence of HCC among regular aspirin users [HR (95% CI): 0.46(0.31-0.67), p < 0.001]. Four studies reported on the PS-matched HR; this showed a 46% reduced incidence of HCC in those using aspirin [HR (95% CI): 0.54(0.38-0.79), p < 0.001]. Subgroup analysis on studies restricted to viral hepatitis (n = 4) showed a 28% reduction in HCC incidence in aspirin users [HR (95% CI): 0.72(0.64-0.80), p < 0.001]. Four studies reported the incidence of major GI bleeds, there was no significant difference between the two groups [HR (95% CI: 1.00(0.69-1.45), p = 0.90]. All outcome analysis, except the subgroup analysis, had significant inter-study heterogeneity. CONCLUSION: Regular aspirin use in chronic liver disease is associated with reduced incidence of HCC without increasing the risk of major GI bleeding.
PURPOSE: Aspirin reduces the incidence of various gastrointestinal (GI) malignancies. This meta-analysis assessed the efficacy and safety of regular aspirin use on the incidence of hepatocellular carcinoma (HCC) in patients with chronic liver disease. METHODS: Electronic reference databases were searched for studies in patients with chronic liver disease exposed to aspirin. The primary outcome was the incidence of HCC in regular aspirin users compared to non-users. The secondary outcome was the incidence of major GI bleeding events in both groups. The propensity score (PS) and non-PS-adjusted pooled hazard ratio (HR) were calculated using random-effects models. RESULTS: Six observational studies with 71,211 subjects were included. The median duration of follow-up ranged from 2.7 to 7.9 years. Four studies included patients with viral hepatitis; five studies used aspirin 100 mg/day. All six studies reported the non-PS-matched HR, and there was a 54% reduction in the incidence of HCC among regular aspirin users [HR (95% CI): 0.46(0.31-0.67), p < 0.001]. Four studies reported on the PS-matched HR; this showed a 46% reduced incidence of HCC in those using aspirin [HR (95% CI): 0.54(0.38-0.79), p < 0.001]. Subgroup analysis on studies restricted to viral hepatitis (n = 4) showed a 28% reduction in HCC incidence in aspirin users [HR (95% CI): 0.72(0.64-0.80), p < 0.001]. Four studies reported the incidence of major GI bleeds, there was no significant difference between the two groups [HR (95% CI: 1.00(0.69-1.45), p = 0.90]. All outcome analysis, except the subgroup analysis, had significant inter-study heterogeneity. CONCLUSION: Regular aspirin use in chronic liver disease is associated with reduced incidence of HCC without increasing the risk of major GI bleeding.
Authors: Tracey G Simon; Ann-Sofi Duberg; Soo Aleman; Raymond T Chung; Andrew T Chan; Jonas F Ludvigsson Journal: N Engl J Med Date: 2020-03-12 Impact factor: 91.245
Authors: Mohsen Malehmir; Dominik Pfister; Suchira Gallage; Marta Szydlowska; Donato Inverso; Elena Kotsiliti; Valentina Leone; Moritz Peiseler; Bas G J Surewaard; Dominik Rath; Adnan Ali; Monika Julia Wolf; Hannah Drescher; Marc E Healy; Daniel Dauch; Daniela Kroy; Oliver Krenkel; Marlene Kohlhepp; Thomas Engleitner; Alexander Olkus; Tjeerd Sijmonsma; Julia Volz; Carsten Deppermann; David Stegner; Patrick Helbling; César Nombela-Arrieta; Anahita Rafiei; Martina Hinterleitner; Marcel Rall; Florian Baku; Oliver Borst; Caroline L Wilson; Jack Leslie; Tracy O'Connor; Christopher J Weston; Abhishek Chauhan; David H Adams; Lozan Sheriff; Ana Teijeiro; Marco Prinz; Ruzhica Bogeska; Natasha Anstee; Malte N Bongers; Mike Notohamiprodjo; Tobias Geisler; Dominic J Withers; Jerry Ware; Derek A Mann; Hellmut G Augustin; Alexandros Vegiopoulos; Michael D Milsom; Adam J Rose; Patricia F Lalor; Josep M Llovet; Roser Pinyol; Frank Tacke; Roland Rad; Matthias Matter; Nabil Djouder; Paul Kubes; Percy A Knolle; Kristian Unger; Lars Zender; Bernhard Nieswandt; Meinrad Gawaz; Achim Weber; Mathias Heikenwalder Journal: Nat Med Date: 2019-04-01 Impact factor: 53.440