The effect of aspirin and nonsteroidal anti-inflammatory drug use after diagnosis on survival of oesophageal cancer patients

Postdiagnosis aspirin use might be associated with a higher survival rate in oesophageal cancer patients. This was shown by a study performed at Leiden University Medical Center with data from the PHARMO Database Network linked to the Eindhoven Cancer Registry. The study, recently published in the British Journal of Cancer, presented a possible association between postdiagnosis aspirin use and overall survival in patients with oesophageal cancer. The effect seemed to be aspirin-specific as the postdiagnosis use of NSAIDs had no significant effect on outcome.

Aspirin use has been shown to lower incidence of multiple cancers and mortality in cancer patients. The aim of this population-based study was to determine the effect of postdiagnosis low-dose aspirin use on survival of patients with oesophageal cancer.

Patients with oesophageal cancer (1998–2010) were selected from the Eindhoven Cancer Registry and linked with the PHARMO Out-patient Pharmacy Database for data on aspirin and nonsteroidal anti-inflammatory drug (NSAIDs) use. Users were subdivided into both prediagnosis and postdiagnosis or only postdiagnosis users. Parametric survival models with an exponential (Poisson) distribution were used with non-specific death as endpoint.

In this study 560 patients were included. Overall, 157 patients (28.0%) were non-users, 293 patients (52.3%) pre- and postdiagnosis (89 aspirin and 204 NSAID users) and 110 patients (19.6%) only postdiagnosis users (16 aspirin and 94 NSAID users). Postdiagnosis aspirin use was associated with overall survival (RR 0.45 (95% CI: 0.34–0.60; P<0.001)); adjusted rate ratio was 0.42 (95% CI: 0.30–0.57; P<0.001). Postdiagnosis use of NSAIDs was associated with overall survival (RR 0.61 (95% CI: 0.49–0.76; P<0.001)); however, adjusted analyses did not show a significant association with a rate ratio of 0.84 (95% CI: 0.66–1.07; P=0.2).

This study showed that postdiagnosis aspirin use might be associated with a higher survival rate in oesophageal cancer patients. A randomised clinical trial is needed to verify these observations of possible postdiagnosis aspirin use benefit.

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