Low-dose aspirin and incidence of lung carcinoma in patients with chronic obstructive pulmonary disease in Hong Kong: A cohort study

Abstract

Background Evidence suggests that chronic obstructive pulmonary disease (COPD) is associated with a higher risk of lung carcinoma. Using a territory-wide clinical electronic medical records system, we investigated the association between low-dose aspirin use (≤160 mg) among patients with COPD and incidence of lung carcinoma and the corresponding risk of bleeding. Methods and findings This is a retrospective cohort study conducted utilizing Clinical Data Analysis Reporting System (CDARS), a territory-wide database developed by the Hong Kong Hospital Authority. Inverse probability of treatment weighting (IPTW) was used to balance baseline covariates between aspirin nonusers (35,049 patients) with new aspirin users (7,679 patients) among all eligible COPD patients from 2005 to 2018 attending any public hospitals. The median age of the cohort was 75.7 years (SD = 11.5), and 80.3% were male. Competing risk regression with Cox proportional hazards model were performed to estimate the subdistribution hazard ratio (SHR) of lung carcinoma with low-dose aspirin and the associated bleeding events. Of all eligible patients, 1,779 (4.2%, 1,526 and 253 among nonusers and users) were diagnosed with lung carcinoma over a median follow-up period of 2.6 years (interquartile range [IQR]: 1.4 to 4.8). Aspirin use was associated with a 25% lower risk of lung carcinoma (SHR = 0.75, 95% confidence interval [CI] 0.65 to 0.87, p = <0.001) and 26% decrease in lung carcinoma–related mortality (SHR = 0.74, 95% CI 0.64 to 0.86, p = <0.001). Subgroup analysis revealed that aspirin was beneficial for patients aged above or below 75 years, but was also beneficial among populations who were male, nondiabetic, and nonhypertensive. Aspirin use was not associated with an increased risk of upper gastrointestinal bleeding (UGIB) (SHR = 1.19, 95% CI 0.94 to 1.53, p = 0.16), but was associated with an increased risk of hemoptysis (SHR = 1.96, 95% CI 1.73 to 2.23, p < 0.001). The main limitations of the study were (i) that one group of patients may be more likely to seek additional medical attention, although this was partially mitigated by the use of propensity score analysis; and (ii) the observational nature of the study renders it unable to establish causality between aspirin use and lung carcinoma incidence. Conclusions In this study, we observed that low-dose aspirin use was associated with a lower risk of lung carcinoma and lung carcinoma–related mortality among COPD patients. While aspirin was not associated with an increased risk of UGIB, the risk of hemoptysis was elevated.

Mechanism of lnRNA-ICL involved in lung cancer development in COPD patients through modulating microRNA-19-3p/NKRF/NF-κB axis

“…The study data showed that use of aspirin was associated with a 25% reduction in LC risk (SHR = 0.75, 95% confidence interval 0.65 to 0.87, p ≤ 0.001) and a 26% reduction in LC related mortality (SHR = 0.74, 95% confidence interval 0.64 to 0.86, p ≤ 0.001) in COPD patients. Therefore, the author believed that aspirin might be a potential drug for treatment of LC in patients with COPD [ 20 ]. Although the current retrospective study should not be regarded as sufficient evidence to include aspirin in the management strategy of COPD, the protective association between aspirin and LC deserves to be clarified by future randomized studies.…”

Aspirin boosts the synergistic effect of EGFR/p53 inhibitors on lung cancer cells by regulating AKT/mTOR and p53 pathways

“…An interesting finding was that the current study used a low dose of aspirin, which is a controversial topic in its application to prevent cancer. In clinical trials, although some studies found that the cancer prevention effect of aspirin to be less robust or questionable, 31,32 some studies showed that low-dose aspirin was associated with a lower risk of lung cancer, 11 hepatocellular carcinoma, 12 colorectal cancer. 13 Our results provide further indirect support that aspirin has a cancer-preventive effect and that it increases the sensitivity of cancer cells to other agents.…”

“…Aspirin is a commonly used anti‐inflammatory drug, while it has provided important information on the prevention and treatment of several types of cancer 11–13 . Aspirin alone or in combination with other agents has shown unique efficacy in the process of cancer treatment in preclinical experiments 14–22 .…”

“…Aspirin is a commonly used anti-inflammatory drug, while it has provided important information on the prevention and treatment of several types of cancer. [11][12][13] Aspirin alone or in combination with other agents has shown unique efficacy in the process of cancer treatment in preclinical experiments. [14][15][16][17][18][19][20][21][22] In the present study, we first investigated the effect and mechanism of triple therapy with aspirin, afatinib, and vinorelbine on three types of p53 wild-type NSCLC cells.…”

Pleiotropic effects of acetylsalicylic acid

“…АСК -это лекарственное средство с потенциальным противоопухолевым действием [29][30][31], однако ее влияние на рак легких изучено недостаточно. В ретроспективном когортном исследовании, проведенном с использованием системы электронных медицинских карт в Гонконге, изучали связь между использованием низких доз АСК (<160 мг) среди пациентов с ХОБЛ и частотой развития карциномы легких и риском кровотечения [32]. Анализировались данные медицинской документации всех пациентов с ХОБЛ, посещавших любые государственные больницы в период с 2005 по 2018 г. Не принимали АСК 35 049 пациентов, начали ее принимать 7679.…”