Hong Kong study: Only low doses can reduce the risk of lung cancer and death by 1/4 in COPD patients!

Lung cancer is the most common malignancy worldwide, with an estimated incidence of 2.
1 million cases and 1.
8 million deaths in 2018
.

There are currently 1 billion smokers in the world, and they are at greater risk

Lung Cancer Prevention

Previous studies have shown that aspirin prevents exacerbations, reduces hospitalizations, and improves lung function and survival in patients with COPD
.

In addition, both experimental and clinical data suggest that aspirin prevents carcinogenesis in various systems

Digestion

1.
Participant characteristics

Of the 89,988 COPD patients diagnosed between 2005 and 2018, 42,728 were eligible, including 35,049 aspirin nonusers and 7,679 aspirin users (Figure 1)
.

Baseline characteristics of the entire cohort are shown in (Table 1)

Diagnosing Vascular Diabetes Hypertension

2.
Lung cancer

During a median follow-up of 2.
6 years (interquartile range [IQR]: 1.
4 to 4.
8), 1,779 patients (4.
2%) were diagnosed with lung cancer in 148,683 person-years
.

The median age at lung cancer diagnosis was 78.

Figure 2 After adjustment of multivariate, the risk of pulmonary cancer in aspirin is 25% lower than that of non-service users (Table 2, SHR = 0.

A total of 26,186 deaths occurred during follow-up, of which 1,694 (6.
0%) were attributable to lung cancer
.

After taking non-lung cancer causes of death and lung resection as competing risks, aspirin use was associated with a 26% reduction in lung cancer-related mortality compared with non-users (SHR = 0.

The histological classification of lung cancer was searchable and 832 cases were reported ( Table 3 )
.

This included 116 cases of small cell lung cancer and 716 cases of non-small cell lung cancer

Table 3 Statistics

3.
Subgroup analysis

The results of the subgroup analysis are summarized in Table 4
.

Aspirin users versus nonusers in two groups aged >75 years or ≤75 years, male, nondiabetic, nonhypertensive, inhaled steroid users or nonusers, antimuscarinic only Drug and antimuscarinic combined beta-agonist bronchodilator users, statin non-users, and non-aspirin non-steroidal anti-inflammatory drug users were associated with a lower incidence of lung cancer

Table 4

4.
Bleeding

From the date of the indicator date to the patient's death , 12,581 cases of bleeding diagnosis were recorded (Table 5) in 7194 patients
.
After adjusting age, gender, common disease, concurrent drug use and socioeconomic status agents, Poisson returns to the count ratio of aspirin tabers and non-service users (95% CI 1.
30 - 1.
36, P < 0.
001)
.
Only the survival functions of the first bleeding time, after multiple factors adjusted, aspirin users' SHR is 1.
78, rather than 1.
78 (95% CI is 1.
68 - 1.
89, P = 0.
001)
.
Compared with non-users, aspirin is not related to UGIB, especially multivariate adjustments (SHR = 1.
19, 95% Ci 0.
94 - 1.
53, P = 0.
16), and the 5-year incidence is 0.
7% and 0.
8%, respectively
.
However, in a multi-factor adjustment, it is obviously related to higher hemopolicity compared to those who do not take aspirin (SHR = 1.
96, 95% Ci 1.
73 - 2.
23, P <0.
001)
.
When aspirin users have been reviewed by other antiplatelets, aspirin has weakened the risk of overall bleeding, UGIB and hemopatum, while maintaining statistical significance ( S7 table )
.
The uncomfortable results are shown in Table 5 and S7 tables
.
Since Aspirin is likely to stop the drug during bleeding, we have sensitively analyzed the relationship between aspirin and lung cancer.
At the same time, it is an additional competitive risk.
In this case, aspirin is compared with non-use.
The use of lung cancer is reduced by 30% (SHR 0.
70, 95% Ci 0.
60 to 0.
82, p  < 0.
001)
.

From index date to patient death A total of 12,581 bleeding diagnoses were recorded among 7,194 patients (Table 5)
.
After adjusting for proxies for age, sex, comorbidities, concurrent drug use, and socioeconomic status, Poisson regression yielded a count ratio of aspirin users to nonusers of 1.
33 (95% CI 1.
30 - 1.
36, p< 0.
001)
.
After adjusting for proxies for age, sex, comorbidities, concurrent drug use, and socioeconomic status, Poisson regression yielded a count ratio of aspirin users to nonusers of 1.
33 (95% CI 1.
30 - 1.
36, p< 0.
001)
.
After multivariate adjustment, the SHR was 1.
78 for aspirin users and 1.
78 for non-users (95% CI 1.
68 - 1.
89, p = 0.
001), especially after multivariate adjustment (SHR = 1.
19, 95% CI 0.
94 - 1.
53 , p = 0.
16), and the 5-year incidence rates were 0.
7% and 0.
8%, respectively
.
However, in multivariate adjustment, those who took aspirin were significantly associated with a higher risk of hemoptysis compared to those who did not take aspirin (SHR = 1.
96, 95% CI 1.
73 - 2.
23, p S7 Table for unadjusted results in table 5 and S7 tables
.
p

Taken together, aspirin use was associated with a 25% reduction in lung cancer risk (SHR = 0.
75, 95% confidence interval [CI] 0.
65 to 0.
87, p  = <0.
001) and a 26% reduction in lung cancer-related mortality (SHR = 0.
74) , 95%CI 0.
64 to 0.
86, p = <0.
001)
.
Subgroup analyses showed that aspirin was beneficial in patients over 75 years of age and in men, non-diabetic and non-hypertensive populations
.
Aspirin use was not associated with an increased risk of upper gastrointestinal = 0.
16), but was associated with an increased risk of hemoptysis (SHR = 1.
96, 95% CI 1.
73 to 2.
23, p <0.
001)
.
Aspirin may serve as a potential preventive treatment for lung cancer in COPD patients, but the increased risk of adverse effects warrants further evaluation
.
Although the current retrospective study should not be considered sufficient evidence to include aspirin in COPD management strategies, the protective association between aspirin and lung cancer deserves to be elucidated through future randomized studies to thoroughly investigate its benefits and associated adverse effects, To enable rigorous cost-benefit analysis and improve patient autonomy in clinical decision-making
.

Aspirin use was associated with a 25% reduction in lung cancer risk (SHR = 0.
75, 95% confidence interval [CI] 0.
65 to 0.
87, p  = <0.
001) and a 26% reduction in lung cancer-related mortality (SHR = 0.
74, 95%) CI 0.
64 to 0.
86, p = < 0.
001)
.
Subgroup analyses showed that aspirin was beneficial in patients over 75 years of age and in men, non-diabetic and non-hypertensive populations
.
Aspirin use was not associated with an increased risk of upper gastrointestinal digest = 0.
16), but was associated with an increased risk of hemoptysis (SHR = 1.
96, 95% CI 1.
73 to 2.
23, p < 0.
001)
.
Although the current retrospective study should not be considered sufficient evidence to include aspirin in COPD management strategies, the protective association between aspirin and lung cancer deserves to be elucidated through future randomized studies to thoroughly investigate its benefits and associated adverse effects, To enable rigorous cost-benefit analysis and improve patient autonomy in clinical decision-making
.
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Original source:

Si-Yeung Yu ,et al.
Low-dose aspirin and incidence of lung carcinoma in patients with chronic obstructive pulmonary disease in Hong Kong: A cohort study.

Si-Yeung Yu

PLOS Medicine | https://doi.
org/10.
1371/journal.
pmed.
1003880 January 13, 2022

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