Effect of low-dose aspirin use on pancreatic cancer development and morphological changes on imaging in IPMN: A long-term cohort study

Abstract

Background: Aspirin use may reduce the incidence of pancreatic cancer (PC), but no data are available regarding its chemopreventive effects on intraductal papillary mucinous neoplasm (IPMN). We aimed to determine whether low-dose aspirin (LDA) reduces PC development and morphological changes on imaging in IPMN patients. Methods: A cohort of 448 IPMN patients periodically followed up with imaging tests was analyzed. We used one-to-two propensity score matching to adjust for differences between an LDA group (n ¼ 63) and a non-LDA group (n ¼ 385). Outcomes included increasing cyst diameter, increasing main pancreatic duct (MPD) diameter, mural nodule (MN) appearance and PC development. Results: After matching, 63 LDA and 126 non-LDA patients were selected. During follow-up (median, 5.5 years), no significant differences were found in increasing cyst diameter, MN appearance, or PC development. However, there were significantly fewer cases of increasing MPD diameter in the LDA group (4.8% vs. 12.7%; p ¼ 0.02). After adjustment for age and sex, LDA still decreased the risk of increasing MPD diameter (hazard ratio, 0.17; p ¼ 0.02). Conclusion: Our results do not support a chemopreventive effect of LDA on PC development. However, LDA reduces further MPD dilation in IPMN patients.

Correlation of Barrett's esophagus with colorectal polyps in Japanese patients: A retrospective chart review

“…Several factors might be related to an increased or decreased risk of Barrett's esophagus and colorectal neoplasms, including the bile acid level, 37-39 gastrin level, 29,40,41 genetic factors, [42][43][44] and treatment with nonsteroidal anti-inflammatory drugs and/or aspirin. 29,[45][46][47][48] The present chart review did not evaluate these factors. There were also several other limitations in the present study.…”

“…Several factors might be related to an increased or decreased risk of Barrett's esophagus and colorectal neoplasms, including the bile acid level, gastrin level, genetic factors, and treatment with nonsteroidal anti‐inflammatory drugs and/or aspirin …”

Cyclooxygenase-2 and Cytosolic Phospholipase A2 Are Overexpressed in Mucinous Pancreatic Cysts

“…It is unclear whether these findings are applicable to pancreatic cysts because most pancreatic adenocarcinomas are thought to arise from PanIN lesions, not MCN or IPMN. In a retrospective Japanese study, low-dose ASA use appeared to prevent further pancreatic duct dilation in patients with main duct IPMN (17). Studies demonstrating inhibition of pancreatic PGE 2 production by higher oral ASA doses, or an oral NSAID, would inform design of chemoprevention trials in patients with pancreatic cysts.…”

Low-Dose Aspirin and Pancreatic Cancer Risk—Reply

“…However, two recent studies are worth noting. The first examined imaging-based morphologic changes in intraductal papillary mucinous neoplasms (IPMNs), precursor lesions for pancreatic cancer, with respect to the use of low-dose aspirin (3). This study suggested that the growth of such cysts may be slowed by the use of low-dose aspirin.…”