Use of aspirin post-diagnosis in a cohort of patients with colorectal cancer and its association with all-cause and colorectal cancer specific mortality

McCowan, Colin; Munro, Alastair J.; Donnan, Peter T.; Steele, Robert

doi:10.1016/j.ejca.2012.10.024

Cited by 87 publications

(78 citation statements)

References 39 publications

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“…Aspirin use after colorectal cancer diagnosis has also been associated with lower colorectal and overall mortality (70)(71)(72)(73)(74). Furthermore, in patients with myocardial infarction, use of NSAIDs has been associated with lower CRP concentrations (75,76).…”

Section: Discussionmentioning

confidence: 99%

C-Reactive Protein and Colorectal Cancer Mortality in U.S. Adults

Goyal¹,

Terry

Jin

et al. 2014

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: Chronic inflammation has been associated with colorectal cancer. Prediagnostic levels of C-reactive protein (CRP), a highly sensitive marker of inflammation, have been weakly associated with increased colorectal cancer incidence, but few data are available examining its relationship with colorectal cancer mortality.Methods: In the Third National Health and Nutrition Examination Survey (NHANES III), 65% of the 15,924 adult participants had CRP levels 0.21 mg/dL. Using this as the reference group, we calculated hazard ratios (HR) for higher CRP categories and colorectal cancer mortality, and compared them with HRs for other mortality causes.Results: Over a median follow-up period of 14.2 years, there were 92 deaths from colorectal cancer. Compared with the reference group, multivariable adjusted HRs for colorectal cancer mortality were 2.66 [95% confidence interval (CI), 1.36-5.20] for CRP levels 0.22-0.50 mg/dL; 3.40 (95% CI, 1.48-7.77) for levels 0.51-1.00 mg/dL; and 3.96 (95% CI, 1.64-9.52) for levels >1.00 mg/dL. Estimates for colorectal cancer mortality did not change appreciably after excluding deaths within the first 3 years or by limiting follow-up to 5 or 10 years.Conclusions: In a large representative study of U.S. adults, we observed strong dose-response associations between CRP levels and colorectal cancer mortality.Impact: Further evaluation of CRP may help identify high-risk groups for colorectal cancer screening and those who might benefit most from prophylactic anti-inflammatory therapy. Cancer Epidemiol Biomarkers Prev; 23(8); 1609-18. Ó2014 AACR.

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Section: Discussionmentioning

confidence: 99%

C-Reactive Protein and Colorectal Cancer Mortality in U.S. Adults

Goyal¹,

Terry

Jin

et al. 2014

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…It is also possible that NSAIDs may improve survival via alternative biologic mechanisms, including antiplatelet activity. Recent studies suggest that low-dose aspirin may improve survival among patients with colorectal cancer (12,59), despite the selectivity of the inhibition of PTGS to platelets at these doses (60).…”

Section: Discussionmentioning

confidence: 99%

PTGS2 (Cyclooxygenase-2) Expression and Survival among Colorectal Cancer Patients: A Systematic Review

Kunzmann¹,

Murray

Cardwell

et al. 2013

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: Studies have examined whether tumor expression of PTGS2 (also known as COX-2), an enzyme inhibited by nonsteroidal anti-inflammatory drugs such as aspirin, is associated with prognosis in patients with colorectal cancer. However, results to date have been mixed.Methods: Using terms for PTGS2 and colorectal cancer, the Medline, Embase, and Web of Science databases were systematically searched for studies published, in any language, until December 2011. Random effects meta-analyses were used to calculate pooled HRs [95% confidence intervals (CI)] for the association between PTGS2 expression and tumor recurrence, colorectal cancer-specific survival, and overall survival.Results: In total, 29 studies, which had prognostic data on 5,648 patients, met the inclusion criteria. PTGS2-positive patients were at an increased risk of tumor recurrence (n ¼ 9 studies; HR, 2.79; 95% CI, 1.76-4.41; P < 0.001) and had poorer colorectal cancer-specific survival (n ¼ 7; HR, 1.36; 95% CI, 1.02-1.82; P ¼ 0.04). However, there was funnel plot asymmetry, possibly due to publication bias, for the association with cancerspecific survival but less so for recurrence. PTGS2 expression was not associated with overall survival [(n ¼ 16; pooled unadjusted HR, 1.30; 95% CI, 0.94-1.79; P ¼ 0.11) and (n ¼ 9; pooled adjusted HR, 1.02; 95% CI, 0.72-1.45;Conclusions: PTGS2 expression was associated with an increased risk of tumor recurrence and poorer colorectal cancer-specific survival but not overall survival among patients with colorectal cancer. However, confounding by tumor characteristics such as tumor stage seems likely.Impact: There is insufficient evidence to recommend PTGS2 expression as a prognostic marker in patients with colorectal cancer. Furthermore, studies providing adjusted results are required. Cancer Epidemiol Biomarkers Prev; 22(9); 1490-7. Ó2013 AACR.

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“…Colorectal cancer is well characterized in this regard, with the majority of studies conducted among prospective cohorts of patients diagnosed with colorectal cancer reporting lower colorectal cancer-specific mortality among users of any aspirin or non-aspirin NSAIDs. [76][77][78][79][80][81][82] Specifically, post-diagnosis use of aspirin or non-aspirin NSAIDs is associated with statistically significant lower colorectal cancer-specific mortality, 76 (the phosphatidylinositol-4,5-bisphosphonate 3-kinase, catalytic subunit alpha polypeptide gene). 81 Post-diagnosis use of aspirin or non-aspirin NSAIDs may reduce risk of recurrence and/or cancer-specific mortality in patients with breast [83][84][85][86][87][88][89][90] and prostate [91][92][93][94][95][96] cancers; however, the results are somewhat conflicting and additional studies examining these associations across the different molecular subtypes of breast and prostate cancers may help clarify the role of these medications in patient outcomes.…”

Section: Cancer Outcomesmentioning

confidence: 99%

Esophageal Adenocarcinoma: The Influence of Medications Used to Treat Comorbidities on Cancer Prognosis

Thrift

2015

Clinical Gastroenterology and Hepatology

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Use of aspirin post-diagnosis in a cohort of patients with colorectal cancer and its association with all-cause and colorectal cancer specific mortality

Cited by 87 publications

References 39 publications

C-Reactive Protein and Colorectal Cancer Mortality in U.S. Adults

C-Reactive Protein and Colorectal Cancer Mortality in U.S. Adults

PTGS2 (Cyclooxygenase-2) Expression and Survival among Colorectal Cancer Patients: A Systematic Review

Esophageal Adenocarcinoma: The Influence of Medications Used to Treat Comorbidities on Cancer Prognosis

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