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Aspirin use and lung cancer risk: a possible relationship? Evidence from an updated meta-analysis.

Jiang HY, Huang TB, Xu L, Yu J, Wu Y, Geng J, Yao XD - PLoS ONE (2015)

Bottom Line: Besides, when analysis was restricted to long time regular aspirin use (>5 years), insignificant results were reported in both cohort and case-control studies.Finally, regular aspirin use might result in higher reduction of non-small cell lung cancer incidence among men.Our findings do not support the protective effect of regular aspirin use on lung cancer risk.

View Article: PubMed Central - PubMed

Affiliation: Electrocardiographic room, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China.

ABSTRACT

Background and purpose: Growing evidence has emerged and controversial results reported on possible relationship between aspirin use and lung cancer risk. We, therefore, conducted this updated and comprehensive meta-analysis to evaluate this issue, with focus on dose-risk and duration-risk relationships.

Methods: We searched electronic databases including PUBMED, EMBASE and Cochrane library to identify eligible studies. Relative risk (RR) and its 95% confidence interval (CI) were used for cohort studies, while odds ratio (OR) were employed for case-control studies. The random effects and fixed effects models were used for analyses.

Results: 18 studies were identified including 19835 lung cancer cases, which were eligible for inclusion in the present meta-analysis. Pooled data from case-control studies showed a significant inverse association between regular aspirin use and lung cancer risk. But for cohort studies, insignificant association was detected with little evidence of heterogeneity (RR: 1.05, 95%CI: 0.95 - 1.16; I2: 10.3%, p value: 0.351). In case-control studies, standard aspirin use (>325mg) was related to lower lung cancer incidence, compared with low-dose aspirin use (75-100mg). A similar trend was observed in cohort studies. Besides, when analysis was restricted to long time regular aspirin use (>5 years), insignificant results were reported in both cohort and case-control studies. Finally, regular aspirin use might result in higher reduction of non-small cell lung cancer incidence among men.

Conclusions: Our findings do not support the protective effect of regular aspirin use on lung cancer risk. Long time aspirin use, sex, dose and type of lung cancer might alter the effect of aspirin use on lung cancer risk. More well-designed studies are needed to further clarify these associations.

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Begg’s funnel plot of studies on aspirin use and risk of lung cancer for evaluation of publication bias.
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pone.0122962.g004: Begg’s funnel plot of studies on aspirin use and risk of lung cancer for evaluation of publication bias.

Mentions: Any aspirin use was associated with a decreased risk of lung cancer in case-control studies with a large evidence of heterogeneity (pooled OR: 0.71, 95%CI: 0.56–0.91; I2: 82.3%). However, no association was detected in cohort studies (pooled RR: 0.97, 95%CI: 0.81–1.15). There was also some evidence of heterogeneity, which could be subsided by excluding the two studies[29, 30] that did not adjust for smoking (I2 = 55.2%, I2 = 10.3%, respectively) (detailed estimated data are shown in Table 2 and Table 3). As for regular standard aspirin use, similar insignificant results were obtained in cohort studies (pooled RR: 0.97, 95%CI: 0.82–1.15) (Fig 2). However, in case-control studies, a stronger inverse association was detected (pooled OR: 0.61, 95%CI: 0.42–0.89). For low-dose regular aspirin use, both groups did not yield any significant associations, which confirmed the data abstracted from a post-trial of RCT [12]. In this large-scale study, 33682 women were included; after over ten years of follow-up, no significant association was found between the 100mg alternate-day aspirin use group and placebo patients (HR: 1.04, 95%CI: 0.86–1.26). Some of the included studies[7, 8, 10, 18, 20, 22–25, 28] reported the estimated data about long time aspirin use and lung cancer risk. The pooled estimates revealed similar results as regular aspirin use (Fig 3). Furthermore, we conducted a subgroup analysis based on gender and found that males may benefit more from aspirin use than females (pooled RR for men: 0.83, 95%CI: 0.48–1.41; pooled RR for females: 1.02, 95%CI: 0.70–1.47). However, statistical significance level was not reached. After stratification by pathological type, we found that aspirin might protect more people suffering from NSCLC (pooled RR: 0.67, 95%CI: 0.25–1.86). Finally, obvious publication bias was found by Egger’s (P = 0.015) and Begg’s (P = 0.028) tests (Fig 4). Subsequently, sensitivity analyses indicated that no single study influenced the pooled RR qualitatively.


Aspirin use and lung cancer risk: a possible relationship? Evidence from an updated meta-analysis.

Jiang HY, Huang TB, Xu L, Yu J, Wu Y, Geng J, Yao XD - PLoS ONE (2015)

Begg’s funnel plot of studies on aspirin use and risk of lung cancer for evaluation of publication bias.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4388842&req=5

pone.0122962.g004: Begg’s funnel plot of studies on aspirin use and risk of lung cancer for evaluation of publication bias.
Mentions: Any aspirin use was associated with a decreased risk of lung cancer in case-control studies with a large evidence of heterogeneity (pooled OR: 0.71, 95%CI: 0.56–0.91; I2: 82.3%). However, no association was detected in cohort studies (pooled RR: 0.97, 95%CI: 0.81–1.15). There was also some evidence of heterogeneity, which could be subsided by excluding the two studies[29, 30] that did not adjust for smoking (I2 = 55.2%, I2 = 10.3%, respectively) (detailed estimated data are shown in Table 2 and Table 3). As for regular standard aspirin use, similar insignificant results were obtained in cohort studies (pooled RR: 0.97, 95%CI: 0.82–1.15) (Fig 2). However, in case-control studies, a stronger inverse association was detected (pooled OR: 0.61, 95%CI: 0.42–0.89). For low-dose regular aspirin use, both groups did not yield any significant associations, which confirmed the data abstracted from a post-trial of RCT [12]. In this large-scale study, 33682 women were included; after over ten years of follow-up, no significant association was found between the 100mg alternate-day aspirin use group and placebo patients (HR: 1.04, 95%CI: 0.86–1.26). Some of the included studies[7, 8, 10, 18, 20, 22–25, 28] reported the estimated data about long time aspirin use and lung cancer risk. The pooled estimates revealed similar results as regular aspirin use (Fig 3). Furthermore, we conducted a subgroup analysis based on gender and found that males may benefit more from aspirin use than females (pooled RR for men: 0.83, 95%CI: 0.48–1.41; pooled RR for females: 1.02, 95%CI: 0.70–1.47). However, statistical significance level was not reached. After stratification by pathological type, we found that aspirin might protect more people suffering from NSCLC (pooled RR: 0.67, 95%CI: 0.25–1.86). Finally, obvious publication bias was found by Egger’s (P = 0.015) and Begg’s (P = 0.028) tests (Fig 4). Subsequently, sensitivity analyses indicated that no single study influenced the pooled RR qualitatively.

Bottom Line: Besides, when analysis was restricted to long time regular aspirin use (>5 years), insignificant results were reported in both cohort and case-control studies.Finally, regular aspirin use might result in higher reduction of non-small cell lung cancer incidence among men.Our findings do not support the protective effect of regular aspirin use on lung cancer risk.

View Article: PubMed Central - PubMed

Affiliation: Electrocardiographic room, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China.

ABSTRACT

Background and purpose: Growing evidence has emerged and controversial results reported on possible relationship between aspirin use and lung cancer risk. We, therefore, conducted this updated and comprehensive meta-analysis to evaluate this issue, with focus on dose-risk and duration-risk relationships.

Methods: We searched electronic databases including PUBMED, EMBASE and Cochrane library to identify eligible studies. Relative risk (RR) and its 95% confidence interval (CI) were used for cohort studies, while odds ratio (OR) were employed for case-control studies. The random effects and fixed effects models were used for analyses.

Results: 18 studies were identified including 19835 lung cancer cases, which were eligible for inclusion in the present meta-analysis. Pooled data from case-control studies showed a significant inverse association between regular aspirin use and lung cancer risk. But for cohort studies, insignificant association was detected with little evidence of heterogeneity (RR: 1.05, 95%CI: 0.95 - 1.16; I2: 10.3%, p value: 0.351). In case-control studies, standard aspirin use (>325mg) was related to lower lung cancer incidence, compared with low-dose aspirin use (75-100mg). A similar trend was observed in cohort studies. Besides, when analysis was restricted to long time regular aspirin use (>5 years), insignificant results were reported in both cohort and case-control studies. Finally, regular aspirin use might result in higher reduction of non-small cell lung cancer incidence among men.

Conclusions: Our findings do not support the protective effect of regular aspirin use on lung cancer risk. Long time aspirin use, sex, dose and type of lung cancer might alter the effect of aspirin use on lung cancer risk. More well-designed studies are needed to further clarify these associations.

Show MeSH
Related in: MedlinePlus