美国《临床肿瘤杂志》2017年6月15日在线先发
http://ascopubs.org/doi/full/10.1200/JCO.2017.72.3569
在结直肠癌患者中阿司匹林和其它非甾体抗炎药物的使用时机与肿瘤标志物、生存期的相关
性
目的
常规使用阿司匹林可延长结直肠癌患者的生存期，但阿司匹林和其它非甾体抗炎药物的使用时机与生存期的相关性、何种结直肠癌亚型使用这类药物生存期最受益尚不清楚。
患者与方法
总体上，在美国、加拿大和澳大利亚，从以人群为基础的癌症登记处甄别出2419名自1997-2008年诊断出的、年龄18-74岁的新发浸润性结直肠癌患者。在研究入组和随访5年时进行了详细的流行病学调查问卷。通过国家死亡登记处完成了生存结果的调查。还对BRAF和KRAS突变情况、微卫星不稳定性、CpG岛甲基化表型进行了评估。采用Cox比例风险回归，对总生存期（OS）、结直肠癌特异性生存期的风险比（HR）和95%CI进行了估算。
结果
自诊断以来中位随访10.8年后，观察到381名死亡（100名死于结直肠癌）。与未使用阿司匹林者相比，诊断后仅使用阿司匹林者，总生存期（HR，0.75；95%CI，0.59-0.95）和结直肠癌特异性生存期（HR，0.44；95%CI，0.25-0.71）更长，诊断后开始使用阿司匹林者尤其如此（总生存期：HR，0.64；95%CI，0.47-0.86；结直肠癌特异性生存期：HR，0.40；95%CI，0.20-0.80）。结直肠癌诊断后非甾体抗炎药物的使用与总生存期的相关性因KRAS突变情况而明显不同（交互性检验P=0.01），仅在KRAS野生型的肿瘤患者中结直肠癌诊断后使用非甾体抗炎药物与总生存期延长相关（HR，0.60；95%CI，0.46-0.80），而KRAS突变的肿瘤患者中则不相关（HR，1.24；95%CI，0.78-1.96）。
结论
在长期幸存者中，KRAS野生型的肿瘤患者结直肠癌诊断后常规使用甾体抗炎药物与生存期延长明显相关。
《壹篇》南南和北北
Timing of Aspirin and Other Nonsteroidal Anti-Inflammatory Drug Use Among Patients With Colorectal Cancer in Relation to Tumor Markers and Survival
Purpose
Regular use of aspirin is associated with improved survival for patients with colorectal cancer (CRC). However, the timing of and the subtype of CRC that would benefit the most from using aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) in relation to survival is unclear.
Patients and Methods
In all, 2,419 patients age 18 to 74 years with incident invasive CRC who were diagnosed from 1997 to 2008 were identified from population-based cancer registries in the United States, Canada, and Australia. Detailed epidemiologic questionnaires were administered at study enrollment and at 5-year follow-up. Survival outcomes were completed through linkage to national death registries. BRAF- and KRAS-mutation status, microsatellite instability, and CpG island methylator phenotype were also evaluated. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% CIs for overall survival (OS) and CRC-specific survival.
Results
After a median of 10.8 years of follow-up since diagnosis, 381 deaths (100 as a result of CRC) were observed. Compared with nonusers, postdiagnostic aspirin-only users had more favorable OS (HR, 0.75; 95% CI, 0.59 to 0.95) and CRC-specific survival (HR, 0.44; 95% CI, 0.25 to 0.71), especially among those who initiated aspirin use (OS: HR, 0.64; 95% CI, 0.47 to 0.86; CRC-specific survival: HR, 0.40; 95% CI, 0.20 to 0.80). The association between any NSAID use after diagnosis and OS differed significantly by KRAS-mutation status (Pinteraction = .01). Use of any NSAID after diagnosis was associated with improved OS only among participants with KRAS wild-type tumors (HR, 0.60; 95% CI, 0.46 to 0.80) but not among those with KRAS-mutant tumors (HR, 1.24; 95% CI, 0.78 to 1.96).
Conclusion
Among long-term CRC survivors, regular use of NSAIDs after CRC diagnosis was significantly associated with improved survival in individuals with KRAS wild-type tumors.
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