Low-dose aspirin not tied to longer survival with esophageal, gastric cancers

Last Updated: 2017-11-22

By Lorraine L. Janeczko

NEW YORK (Reuters Health) - Patients with esophageal or gastric cancer who take low-dose aspirin do not live longer, new research suggests.

"In analyses of two large independent cohorts in the United Kingdom, low-dose aspirin usage was not associated with increased survival of patients diagnosed with esophageal or gastric cancer," lead author Dr. Andrew D. Spence and colleagues reported online November 6 in Gastroenterology.

"Our findings do not support the conduct of further trials of low-dose aspirin in esophageal or gastric cancer patients," they conclude.

Dr. Spence, of Queen's University Belfast in Northern Ireland, and coauthors conducted a population-based study of patients recently diagnosed with esophageal or gastric cancer, identified from cancer registries, prescription databases, and national mortality records in England and Scotland.

In all, there were 4,654 esophageal cancer and 3,833 gastric cancer patients, and 3,240 and 2,392 cancer-specific deaths, respectively. Survival rates without cancer were compared between aspirin users and nonusers. Among aspirin users, an estimated 98% used low-dose aspirin (75 mg daily).

Survival rates without cancer one year after diagnosis did not differ significantly between aspirin users and nonusers, hovering just below 50% among patients with esophageal cancer and just below 60% among patients with gastric cancer.

Pooled hazard ratios for cancer-specific mortality associated with any aspirin use, compared with nonuse, were nonsignificant for both esophageal cancer (HR, 0.98) and gastric cancer (HR, 0.96). The same was true specifically for long-term aspirin use (HRs, 1.03 and 1.06, respectively).

Dr. Prashanthi N. Thota of Cleveland Clinic, in Ohio, told Reuters Health by email, "The available evidence suggests that aspirin could reduce esophageal and gastric cancer incidence but not improve survival."

"The (current) findings are not surprising. It is disquieting to note that only 50% of patients survive more than one year after the cancer diagnosis," she said.

"The main limitation of the study is the lack of information about factors that are known to affect survival in cancer patients, such as smoking, obesity, and stage of cancer," added Dr. Thota, who was not involved in the study.

Dr. Andrew T. Chan, of Massachusetts General Hospital in Boston, said in an email, "Some limited data suggest that aspirin is associated with a lower risk of mortality in patients with gastric or esophageal cancer. However, further studies are needed, particularly in which information is available about the use of aspirin both before and after diagnosis."

"Although there are limitations to the study, including the fact that aspirin use was self-selected, which could introduce potential confounding, it does highlight the need for more studies in additional populations to address this question. Ideally, these studies would examine the effect of aspirin on survival in the context of other factors known to affect survival, including cancer treatment," advised Dr. Chan, who also was not involved in the study.

Dr. Spence did not respond to requests for comment.

SOURCE: http://bit.ly/2hKXU6o

Gastroenterology 2017.