Aspirin Use and the Incidence of Hepatocellular Carcinoma in Patients With Hepatitis B Virus or Hepatitis C Virus Infection: A Meta-Analysis of Cohort Studies

Abstract

Background: The association between aspirin use and the incidence of hepatocellular carcinoma (HCC) in patients with hepatitis B virus (HBV) or hepatitis C (HCV) virus infection remains not fully determined. A meta-analysis was performed to summarize the findings of cohort studies.Methods: Relevant cohort studies were retrieved via a search of PubMed Cochrane's Library and Embase databases. A random-effect model was used to pool the results. Subgroup analyses were performed to evaluate the influence of study characteristics on the association.Results: Seven cohort studies with 120,945 adult patients with HBV or HCV infection were included. Pooled results showed that aspirin use was independently associated with a reduced risk of HCC in these patients (risk ratio: 0.73, 95% confidence interval: 0.64 to 0.83, p < 0.001; I2 = 86%). Subgroup analyses showed that aspirin use was associated with a reduced HCC risk regardless of the viral type, age, sex, the diabetic, and cirrhotic status of the patients, and the follow-up durations. Moreover, consistent results were obtained in studies with and without adjustment of antiviral treatment and statin use. Pooled results of four studies showed that aspirin use was associated with an increased risk of gastrointestinal bleeding in these patients (risk ratio: 1.15, 95% confidence interval: 1.02 to 1.28, p = 0.02; I2 = 0%).Conclusions: Aspirin use was independently associated with a reduced risk of HCC in patients with HBV or HCV infection, whereas the risk of gastrointestinal bleeding may be increased. These results should be validated in clinical trials.

2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma

“…36 Recent metaanalyses of population-based cohorts or at-risk patients with chronic liver disease revealed that aspirin was associated with a significantly decreased risk of HCC development (HR, 0.51-0.59; RR, 0.73). [37][38][39] However, aspirin use was reported to slightly increase the risk (RR, 1.15-1.32) of gastrointestinal bleeding as a major adverse event; 37,38 therefore, the potential benefits from aspirin must be weighed against the potential for bleeding in patients with chronic liver disease. Particularly, the benefits from aspirin use regarding lowering HCC risk were reportedly lacking (aHR, 1.00; 95% CI, 0.85-1.18) in patients with HBV-related cirrhosis in a recent analysis of Korean population-based administrative database.…”

Aspirin and Infection: A Narrative Review

“…Moreover, Xiaofei Li and colleagues performed a meta-analysis of seven cohort studies involving 120,945 adult patients with hepatitis B virus (HBV) or HCV infection. Pooled results showed that ASA use was independently associated with a reduced risk of HCC [ 151 ]. Some preclinical evidence also supports ASA’s role in liver disease prevention and progression for hepatocellular carcinoma and hepatitis.…”

Statin and aspirin for chemoprevention of hepatocellular carcinoma: Time to use or wait further?

“…6 In contrast, a subgroup analysis using Korean and Taiwanese National Health Insurance database found no association between aspirin and HCC in cirrhotic patients 66,69,70 . Lastly, a recent meta-analysis of individuals with viral hepatitis demonstrated that aspirin use was associated with a lower risk of HCC but the risk reduction rate was smaller than in non-cirrhotic patients (HR = 0.85, 95% CI: 0.76-0.95, HR = 0.64, 95% CI: 0.50, 0.83) 78 .…”