Aspirin use tied to reduced liver-cancer risk in chronic hepatitis B

By Reuters Staff

NEW YORK (Reuters Health) - 28/3/2019

Daily aspirin therapy is associated with a lower risk of hepatocellular carcinoma (HCC) in hepatitis B patients, new findings show.

"Our findings may be of help in future efforts to further improve the chemoprevention of HBV-related HCC, and a proof-of-concept study is thus warranted," Dr. Teng-Yu Lee of Taichung Veterans General Hospital in Taichung, Taiwan, and colleagues conclude in JAMA Internal Medicine, online March 18.

Most patients with chronic hepatitis B are not candidates for antiviral therapy, and those who are able to take antivirals reduce, but don't eliminate, their risk of HCC, the authors note.

Aspirin has been shown in clinical studies to have chemopreventive effects against colorectal cancer. To investigate whether aspirin could also reduce HCC risk, the authors looked at more than 10,000 patients with chronic hepatitis B from the country's National Health Insurance Research Database.

They matched 2,123 patients who had received daily aspirin for at least 90 days to 8,492 who had never received antiplatelet therapy, using propensity scores.

At five years, cumulative HCC incidence was 5.20% in the aspirin group and 7.87% in the untreated group (P<0.001). Multivariate analysis confirmed that aspirin use was independently associated with lower HCC risk (hazard ratio, 0.71).

Other factors independently associated with increased HCC risk included older age (HR 1.01 per year), male sex (HR 1.75) and cirrhosis (HR 2.89), while both nucleos(t)ide and statin therapy were linked to reduced risk (HR, 0.54 and 0.62, respectively).

Although the findings did not suggest an increased risk of peptic ulcer bleeding in the aspirin group, Dr. Lee and colleagues note, "the benefits and harms of aspirin therapy should be weighed as recommended in practice guidelines. In addition, aspirin use in patients with cirrhosis should be monitored carefully, because stopping bleeding in them can be more difficult than in patients without cirrhosis."

They conclude: "Before aspirin therapy is broadly adopted for HCC prevention in practice, a prospective trial should be conducted to assess its efficacy and safety."

SOURCE: https://bit.ly/2FF9ega and https://bit.ly/2uxFIDO JAMA Intern Med 2019.

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