In a study reported in The New England of Medicine, Tracey G. Simon, MD, MPH, and colleagues found that low-dose aspirin use was associated with a reduced risk of hepatocellular carcinoma and liver-related mortality among patients with chronic hepatitis B or C infection.
Tracey G. Simon, MD, MPH
The study involved data from nationwide Swedish registries on patients diagnosed with chronic hepatitis B or hepatitis C from 2005 through 2015 (50,275 patients; 13,276 with hepatitis B and 36,999 with hepatitis C). Of these, 36,070 were aspirin nonusers; patients who were initiating low-dose aspirin (14,205 patients) were identified by their first filled prescriptions for 90 or more consecutive doses.
Patients excluded from the study included those who had received a previous diagnosis of human immunodeficiency virus or hepatocellular carcinoma or who filled prescriptions for aspirin or other antiplatelet agents before the end of the 180-day entry period.
Association With Hepatocellular Carcinoma and Liver-Related Mortality
The median follow-up was 7.9 years. Overall, there were 1,612 incident cases of hepatocellular carcinoma and 5,017 liver-related deaths.
The estimated cumulative incidence of hepatocellular carcinoma was 4.0% among aspirin users vs 8.3% among nonusers (difference = −4.3%, 95% confidence interval [CI] = −5.0 to −3.6%). Multivariate analysis yielded an adjusted hazard ratio [HR] of 0.69 (95% CI = 0.62–0.76).
The magnitude of risk reduction appeared to be dependent on the duration of aspirin use. Thus, on multivariate analysis, compared with short-term aspirin use (3 months to < 1 year), the adjusted hazard ratios were 0.90 (95% CI = 0.76–1.06) for 1 to less than 3 years of use, 0.66 (95% CI = 0.56–0.78) for 3 to less than 5 years of use, and 0.57 (95% CI = 0.42–0.70) for 5 or more years of use.
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Ten-year liver-related mortality was 11.0% among aspirin users and 17.9% among nonusers (difference = −6.9%, 95% CI = −8.1 to −5.7%). On multivariate analysis, the adjusted hazard ratio was 0.73 (95% CI = 0.67–0.81). The 10-year risk of gastrointestinal bleeding was 7.8% among aspirin users vs 6.9% among nonusers (difference = 0.9%, 95% CI = −0.6 to 2.4%).
The investigators concluded, “In a nationwide study of patients with chronic viral hepatitis in Sweden, use of low-dose aspirin was associated with a significantly lower risk of hepatocellular carcinoma and lower liver-related mortality than no use of aspirin, without a significantly higher risk of gastrointestinal bleeding.”
Disclosure: The study was funded by the National Institutes of Health and others. For full disclosures of the study authors, visit nejm.org.The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.