The chemoprotective effect of anti-platelet agents on cancer incidence in people with non-alcoholic fatty liver disease (NAFLD): a retrospective cohort study.

IF 7 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

BMC Medicine Pub Date : 2024-12-03 DOI:10.1186/s12916-024-03802-4

Matthew Anson, Jun Shang Poon, Alex E Henney, David Riley, Gema H Ibarbaru, Cyril Sieberhagen, Daniel J Cuthbertson, Uazman Alam, Theresa Hydes

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引用次数: 0

Abstract

Background: Non-alcoholic fatty liver disease (NAFLD) is associated with an increased incidence of hepatic and extrahepatic cancers, in particular those linked to obesity. In people with chronic liver disease, aspirin may confer protection against hepatocellular carcinoma (HCC). We explore the potential chemoprotective effect of aspirin/other anti-platelet agents on obesity-related cancers, including HCC in people with NAFLD.

Methods: We performed a retrospective cohort study of anonymised electronic medical records using the TriNetX network (Cambridge, MA, USA), a global federated database. We identified adults aged 18 or over with a diagnosis of NAFLD, prior to commencing antiplatelet agents. Two groups were created: antiplatelet (1) versus no antiplatelet use (2). We propensity score matched for nine variables. Antiplatelet use was defined as aspirin, ticagrelor, cangrelor, clopidogrel or prasugrel use for at least 1 year. The outcomes of interest were incidence of HCC and other obesity-related cancers. Follow-up was for 5 years. We performed subgroup analyses on aspirin users only and stratified findings for sex and age. Sensitivity analysis was conducted on individuals with 3- and 5-year aspirin exposure.

Results: Post matching, there were 42,192 people per group. Antiplatelet use in people with NAFLD was associated with statistically significant reduction in all obesity-related cancers (HR 0.71, 95% CI 0.65-0.78, p < 0.001) and individually for HCC (HR 0.52, 95% CI 0.40-0.68, p < 0.001), breast carcinoma (HR 0.78, 95% CI 0.66-0.92, p = 0.003), pancreatic carcinoma (HR 0.61, 95% CI 0.47-0.78, p < 0.001) and colorectal carcinoma (HR 0.68, 95% CI 0.56-0.84, p < 0.001). For women, there was a significant reduction in risk of ovarian carcinoma (HR 0.75, 95% CI 0.57-0.98, p = 0.034). Aspirin monotherapy was similarly associated with reduced incidence of HCC (HR 0.46, 95% CI 0.32-0.64, p < 0.001) and all obesity-related cancers (HR 0.71, 95% CI, 0.56-0.90, p = 0.004), with benefits observed in males (HR 0.71, 95% CI 0.56-0.90, p = 0.004), females (HR 0.77, 95% CI 0.67-0.88, p < 0.001) and in older (HR 0.72, 95% CI 0.63-0.82, p < 0.001) but not younger people (HR 0.78, 95% CI 0.60-1.03, p = 0.589).

Conclusions: Aspirin/antiplatelet agents may have a role in primary cancer prevention in people living with NAFLD.

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抗血小板药物对非酒精性脂肪性肝病（NAFLD）患者癌症发病率的化学保护作用：一项回顾性队列研究

背景：非酒精性脂肪性肝病（NAFLD）与肝癌和肝外癌的发病率增加有关，特别是与肥胖有关的肝癌。在慢性肝病患者中，阿司匹林可能对肝细胞癌（HCC）具有保护作用。我们探讨阿司匹林/其他抗血小板药物对肥胖相关癌症的潜在化学保护作用，包括NAFLD患者的HCC。方法：我们使用全球联邦数据库TriNetX网络（Cambridge， MA， USA）对匿名电子病历进行了回顾性队列研究。在开始使用抗血小板药物之前，我们确定了18岁或以上诊断为NAFLD的成年人。创建了两组：抗血小板(1)和不使用抗血小板(2)。我们的倾向评分匹配了9个变量。抗血小板使用定义为阿司匹林、替格瑞洛、康格瑞洛、氯吡格雷或普拉格雷使用至少1年。关注的结果是HCC和其他肥胖相关癌症的发病率。随访5年。我们仅对阿司匹林使用者进行亚组分析，并根据性别和年龄对结果进行分层。对服用阿司匹林3年和5年的个体进行敏感性分析。结果：配对后，每组共42192人。NAFLD患者的抗血小板使用与所有肥胖相关癌症的显著降低相关（HR 0.71, 95% CI 0.65-0.78, p）。结论：阿司匹林/抗血小板药物可能在NAFLD患者的原发性癌症预防中起作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BMC Medicine 医学-医学：内科

CiteScore

13.10

自引率

1.10%

发文量

435

审稿时长

4-8 weeks

期刊介绍： BMC Medicine is an open access, transparent peer-reviewed general medical journal. It is the flagship journal of the BMC series and publishes outstanding and influential research in various areas including clinical practice, translational medicine, medical and health advances, public health, global health, policy, and general topics of interest to the biomedical and sociomedical professional communities. In addition to research articles, the journal also publishes stimulating debates, reviews, unique forum articles, and concise tutorials. All articles published in BMC Medicine are included in various databases such as Biological Abstracts, BIOSIS, CAS, Citebase, Current contents, DOAJ, Embase, MEDLINE, PubMed, Science Citation Index Expanded, OAIster, SCImago, Scopus, SOCOLAR, and Zetoc.