The effect of aspirin and nonsteroidal anti-inflammatory drug use after diagnosis on survival of oesophageal cancer patients

Abstract

Background: Aspirin use has been shown to lower incidence and mortality in cancer patients. The aim of this population-based study was to determine the effect of postdiagnosis low-dose aspirin use on survival of patients with oesophageal cancer.

Aspirin acts in esophageal cancer: a brief review

“…In patients who had undergone esophagectomy, the risk ratio of the group followed by aspirin treatment versus non-aspirin use group was 0.40 (95% CI, 0.20-0.79) while in the patients who received no esophagectomy the risk ratio was 0.45 (95% CI, 0.31-0.66). Moreover, the survival in patients who had only received post-diagnosis aspirin treatment was better than those had received both pre-diagnosis and post-diagnosis aspirin treatment, which could be explained by the hypothesis that the tumor in pre-diagnosis users has survived in presence of aspirin in plasma, it would also survive the similar dose after post-diagnosis aspirin treatment (26 To get more convincing evidence, a multicenter, doubleblind, phase III randomized controlled trial with four parallel cohorts of breast, colorectal, gastro-esophageal and prostate cancer has been in progress in the United Kingdom (28). In this trial, some participants with standard potentially curative treatment for esophageal cancer, which refers to surgery with standard neo-adjuvant or adjuvant therapy, or only primary chemoradiotherapy, will receive regular different dose of aspirin as an adjuvant therapy.…”

“…Later in 2006, a hospital-based case control study with consistent frequency and duration of drug use of aspirin designed by Jayaprakash et al found a significantly lower risk of esophageal cancer in regular aspirin users compared to non-users (OR =0.54; 95% CI, 0.36-0.86) (25). Studies on antitumor effect of aspirin are focusing on the prevention both of occurrence and recurrence of the disease, and it has been showed post diagnosed aspirin use is more likely to be associated with higher survival rates in patients with esophageal cancer (26). In this regard, it is suggested aspirin could be developed as an adjuvant treatment in patients with cancer (18).…”

“…Studies of van Staalduinen et al (26) noticed that non-aspirin NSAIDs have no significant effects on survival or mortality of cancer patients, only does the aspirin have, which suggested an aspirin-specific antitumor effect. Moreover, the aspirin drug concentration required for antitumor use in tumor cells is much higher than the concentration required to inhibit COX-1 or COX-2 expressions (44).…”

“…Since more and more studies of aspirin and non-aspirin NSAIDs suggest that the antitumor effect seems to be aspirinspecific (26,52), new plausible mechanisms based on COXindependent biological effects of aspirin are raised recently.…”

“…The daily dose of aspirin reported in Liu et al study (18) was 50 mg per day, and it should be reduced to 25 mg per day in patients complaining any gastric discomfort. In ADD-aspirin trials (26), the patients under 75 years old are divided into three groups taking either 100 mg aspirin per day, 300 mg aspirin per day or placebos, while patients over 75 years old, are having either 100 mg aspirin or placebo. Consistency of aspirin taking shows better effect on reducing the risk of cancer (66).…”