Aspirin Significantly Prolongs Survival in Patients with Colorectal Cancer

By John Henry Dreyfuss, MDalert.com staff.

Save to PDF OncologyEvidence-Based MedicineGastroenterology By
  • Colorectal cancer patients who used aspirin post-diagnosis were 15% less likely to die vs those who did not use aspirin.
  • Regular use of aspirin is associated with reduced incidence and mortality of colorectal cancer.
  • Trial included 23,162 patients diagnosed with CRC in Norway.
  • Exposure to aspirin was defined as receipt of aspirin prescriptions for more than 6 months after the diagnosis of colorectal cancer.

The use of aspirin (Figure 1) following a colorectal cancer diagnosis (Figure 2) has been independently associated with improved overall survival (OS) and CRC-specific survival (CSS). The Norwegian researchers found that among more than 23,000 colorectal cancer (CRC) patients, those who used aspirin were 15% less likely to die of the disease over the next several years. The results were presented recently in the Journal of Clinical Oncology.

 

Figure 1. Aspirin.

(Sources: Wikimedia/By 14 Mostafa&zeyad (Own work) [CC BY-SA 4.0, via Wikimedia Commons.)

Regular use of aspirin (acetylsalicylic acid) is associated with reduced incidence and mortality of colorectal cancer (Figure 3). However, aspirin as primary prevention is debated because of the risk of bleeding. “Aspirin as secondary prevention may be more justified from a risk-benefit perspective. We have examined the association between aspirin use after the diagnosis of CRC with CSS and OS,” the researchers concluded.

But these findings alone don't prove that aspirin prolongs colon cancer patients' lives. There could be other reasons that aspirin users had better survival odds, according to lead researcher Dr. Kjetil Tasken, a Professor of Medicine at the University of Oslo, in Norway.

Overall, the study found, that 66% of aspirin users were alive after about 3 years versus 58% of nonusers, the study found.

 

Figure 2. Location and appearance of two example colorectal tumors.
(Sources: Wikipedia/By Blausen Medical Communications, Inc.
(Donated via OTRS, see ticket for details) CC BY 3.0/Wikimedia Commons
.)

“When the researchers dug deeper, the benefit was concentrated among patients who'd been taking aspirin before their diagnosis: They were 23% less likely to die of colon cancer—and 14% less likely to die of any cause—than patients who did not use aspirin at all,” according to a report on MedLine Plus.

Recommendations from the U.S. Preventive Services Task Force (above)  suggest that adults aged 50 to 70 should consider taking low-dose aspirin to reduce their risk of colon cancer, as well as and heart disease and stroke.

Figure 3. Longitudinally opened freshly resected colon segment showing a cancer and 4 polyps. Plus a schematic diagram indicating a likely field defect (a region of tissue that precedes and predisposes to the development of cancer) in this colon segment. The diagram indicates sub-clones and sub-sub-clones that were precursors to the tumors.
(Sources: Wikipedia/By Bernstein0275 - Own work, CC BY-SA 3.0/Creative Commons.)
The Analysis

The Norwegian researchers conducted an observational, population-based, retrospective cohort study by linking patients diagnosed with CRC between 2004 and the end of 2011 that included data on patients’ aspirin use. “These registries cover more than 99% of the Norwegian population and include all patients in an unselected and consecutive manner. Exposure to aspirin was defined as receipt of aspirin prescriptions for more than 6 months after the diagnosis of CRC. Multivariable Cox-proportional hazard analyses were used to model survival. The main outcome measures of the study were CSS and OS,” the researchers explained.

A total of 23,162 patients diagnosed with CRC were included in the trial. Of these, 6,102 whom were exposed to aspirin after the CRC diagnosis of (26.3%). The median follow-up time was 3.0 years. A total of 2,071 deaths (32.9%, all causes) occurred among aspirin-exposed patients, of which 1,158 (19.0%) were CRC specific. Among unexposed patients (n = 17,060), there were 7,218 deaths (42.3%), of which 5,375 (31.5%) were CRC specific.

Conclusion

“Aspirin use after the diagnosis of CRC is independently associated with improved CSS and OS,” the researchers concluded.


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