In the Journals

Daily aspirin may reduce HBV-related hepatocellular carcinoma risk

The risk for hepatocellular carcinoma was statistically significantly reduced by 29% in patients with hepatitis B virus who received daily aspirin, according to findings published in JAMA Internal Medicine.

“Antiviral therapy cannot erase hepatocellular carcinoma (HCC) risk in patients with chronic hepatitis B, and it is not indicated for most hepatitis B virus (HBV) carriers,” Teng-Yu Lee, MD, MBA, PhD, from the division of gastroenterology and hepatology at the Taichung Veterans General Hospital, Taiwan, and colleagues wrote. “Another effective way of reducing HCC risk needs to be developed. Aspirin may prevent cancer development, but clinical evidence in patients with HBV-related HCC remains limited.”

Lee and colleagues conducted a nationwide cohort study in Taiwan to determine how daily aspirin therapy affects HBV-related HCC risk. Between 1997 and 2012, the researchers recruited and screened 204,507 patients with chronic HBV.

Patients with confounding conditions were excluded, making a total of 10,615 participants (72.4% men; mean age, 58.8 years). The researchers randomly propensity score-matched 2,123 patients who received daily aspirin for 90 or more consecutive days (treated group) to 8,492 patients who had never received antiplatelet therapy (untreated group) at a 1:4 ratio.

At 5 years, patients in the treated group had a significantly lower cumulative incidence of HCC than those in the untreated group (5.2% vs. 7.87%).

The researchers observed an independent association between aspirin therapy and reduced HCC risk (HR = 0.71; 95% CI, 0.58-0.86) in the multivariable regression analysis. This association was confirmed in sensitivity subgroup analyses.

There was also an independent association between increased HCC risk and older age (HR = 1.01 per year; 95% CI, 1-1.02), male sex (HR = 1.75; 95% CI, 1.43-2.14) and cirrhosis (HR = 2.89; 95% CI, 2.45-3.4). Conversely, nucleos(t)ide analogue (HR = 0.54; 95% CI, 0.41-0.71) and statin use (HR = 0.62; 95% CI, 0.42-0.9) were associated with a decreased HCC risk.

“Daily aspirin therapy may be of help to further improve the chemoprevention of HBV–related hepatocellular carcinoma,” Lee and colleagues concluded.

“Before aspirin therapy is broadly adopted for HCC prevention in practice, a prospective trial should be conducted to assess its efficacy and safety,” they added.

In an accompanying editorial, Rena K. Fox, MD, professor of medicine at the University of California, San Francisco, and colleagues wrote that although the findings by Lee and colleagues improve upon current research, there were limitations of the cohort and study methods, such as the low frequency of aspirin users, that require more examination.

“With the rising incidence and deaths due to HCC across the globe, there is a need for uncomplicated, inexpensive, and effective interventions to reduce HCC incidence,” they wrote. “Patients with HBV are particularly at risk of HCC, and although there is a beneficial role of nucleos(t)ide analogues therapy, because so many patients are not candidates for or lack access to antivirals, an agent such as aspirin holds promise.”

“The potential role for aspirin to be used as chemoprevention for HCC would be relevant to patients worldwide and would bring a change in practice for primary care clinicians and specialists, including gastroenterology, hepatology, infectious diseases, and oncology,” they added. – by Alaina Tedesco

 

Disclosures: Fox and colleagues report no relevant financial disclosures. Lee reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.

The risk for hepatocellular carcinoma was statistically significantly reduced by 29% in patients with hepatitis B virus who received daily aspirin, according to findings published in JAMA Internal Medicine.

“Antiviral therapy cannot erase hepatocellular carcinoma (HCC) risk in patients with chronic hepatitis B, and it is not indicated for most hepatitis B virus (HBV) carriers,” Teng-Yu Lee, MD, MBA, PhD, from the division of gastroenterology and hepatology at the Taichung Veterans General Hospital, Taiwan, and colleagues wrote. “Another effective way of reducing HCC risk needs to be developed. Aspirin may prevent cancer development, but clinical evidence in patients with HBV-related HCC remains limited.”

Lee and colleagues conducted a nationwide cohort study in Taiwan to determine how daily aspirin therapy affects HBV-related HCC risk. Between 1997 and 2012, the researchers recruited and screened 204,507 patients with chronic HBV.

Patients with confounding conditions were excluded, making a total of 10,615 participants (72.4% men; mean age, 58.8 years). The researchers randomly propensity score-matched 2,123 patients who received daily aspirin for 90 or more consecutive days (treated group) to 8,492 patients who had never received antiplatelet therapy (untreated group) at a 1:4 ratio.

At 5 years, patients in the treated group had a significantly lower cumulative incidence of HCC than those in the untreated group (5.2% vs. 7.87%).

The researchers observed an independent association between aspirin therapy and reduced HCC risk (HR = 0.71; 95% CI, 0.58-0.86) in the multivariable regression analysis. This association was confirmed in sensitivity subgroup analyses.

There was also an independent association between increased HCC risk and older age (HR = 1.01 per year; 95% CI, 1-1.02), male sex (HR = 1.75; 95% CI, 1.43-2.14) and cirrhosis (HR = 2.89; 95% CI, 2.45-3.4). Conversely, nucleos(t)ide analogue (HR = 0.54; 95% CI, 0.41-0.71) and statin use (HR = 0.62; 95% CI, 0.42-0.9) were associated with a decreased HCC risk.

“Daily aspirin therapy may be of help to further improve the chemoprevention of HBV–related hepatocellular carcinoma,” Lee and colleagues concluded.

“Before aspirin therapy is broadly adopted for HCC prevention in practice, a prospective trial should be conducted to assess its efficacy and safety,” they added.

In an accompanying editorial, Rena K. Fox, MD, professor of medicine at the University of California, San Francisco, and colleagues wrote that although the findings by Lee and colleagues improve upon current research, there were limitations of the cohort and study methods, such as the low frequency of aspirin users, that require more examination.

“With the rising incidence and deaths due to HCC across the globe, there is a need for uncomplicated, inexpensive, and effective interventions to reduce HCC incidence,” they wrote. “Patients with HBV are particularly at risk of HCC, and although there is a beneficial role of nucleos(t)ide analogues therapy, because so many patients are not candidates for or lack access to antivirals, an agent such as aspirin holds promise.”

“The potential role for aspirin to be used as chemoprevention for HCC would be relevant to patients worldwide and would bring a change in practice for primary care clinicians and specialists, including gastroenterology, hepatology, infectious diseases, and oncology,” they added. – by Alaina Tedesco

 

Disclosures: Fox and colleagues report no relevant financial disclosures. Lee reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.