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The Efficacy of Aspirin in Preventing the Recurrence of Colorectal Adenoma: a Renewed Meta-Analysis of Randomized Trials

  • Zhao, Tai-Yun (Department of Gastroenterology, The People's Hospital of Bozhou) ;
  • Tu, Jing (Department of Gastroenterology, The People's Hospital of Bozhou) ;
  • Wang, Yin (Department of Gastroenterology, The People's Hospital of Bozhou) ;
  • Cheng, Da-Wei (Department of Gastroenterology, The People's Hospital of Bozhou) ;
  • Gao, Xian-Kui (Department of Gastroenterology, The People's Hospital of Bozhou) ;
  • Luo, Hao (Department of Gastroenterology, The People's Hospital of Bozhou) ;
  • Yan, Bi-Chun (Department of Gastroenterology, The People's Hospital of Bozhou) ;
  • Xu, Xiao-Li (Department of Gastroenterology, The People's Hospital of Bozhou) ;
  • Zhang, Hong-Ling (Department of Gastroenterology, The People's Hospital of Bozhou) ;
  • Lu, Xing-Jun (Department of Gastroenterology, The People's Hospital of Bozhou) ;
  • Wang, Yao-Jun (Department of Gastroenterology, the General hospital of Jinan Military Command)
  • Published : 2016.05.01

Abstract

Background: Through search the possible randomized control trials, we make a renewed meta-analysis in order to assess the impact of aspirin in preventing the recurrence of colorectal adenoma. Materials and Methods: The Medicine/PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Chinese biomedical literature service system (SinoMed) databases were searched for the related randomized controlled trials until to the April 2016. Three different authors respectively evaluated the quality of studies and extracted data, and we used the STATA software to analyze, investigate heterogeneity between the data, using the fixed-effects model to calculate and merge data. Results: 7 papers were included the renewed meta-analysis, among these studies, two pairs were identified as representing the same study population, with the only difference being the duration of follow-up. Thus there were only five papers included our meta-analysis, and one Chinese paper were also included the work. Results were categorized by the length of follow-up, different kinds of people, varied dose of oral aspirin. The relative of adenoma in patients taking aspirin vs placebo were 0.73 (95% CI 0.55-0.98, P=0.039) with 1 year follow up; 0.84 (95% CI 0.72-0.98, P=0.484) with greater than 1 year follow up; for the advanced adenoma, the RR 0.68 (95% CI 0.49-0.94, P=0.582),for one year; RR=0.75 (95% CI 0.52-1.07, P=0.552) for greater one year. Furthermore the white population could divided into two subgroups according to the different length of follow-up time. When the length of follow-up time less than 3-year, The RR of two subgroups respective were RR=0.86 (95% CI 0.76-0.98, P=0.332), $I^2=0%$, RR=0.68 (95% CI 0.47-0.98, P=0.552), $I^2=64.6%$, But with the extension of follow-up time greater than 2-year, with the white, oral aspirin without considering dose had no efficacy on preventing the recurrence of any adenoma, the RR was 0.86 (95% CI 0.71-1.05, P=0.302), $I^2=16.4%$. Conclusions: This meta-analysis indicated that oral aspirin is associated with a remarkable decrease in the recurrence of any adenoma and advanced adenomas in patients follow-up for 1 year without concerning the dose of aspirin, but with the extension of follow-up time for greater than 1 year, oral aspirin can be effective on preventing the recurrence of any adenoma, but for the advanced adenoma, the result indicated that oral aspirin had no efficacy, According to the inclusion of ethnic groups, we also divided relevant papers into two subgroups as the yellow and white group. Then the follow-up time was less than 3 years, oral aspirin without considering the dose, had an significant efficacy on preventing the recurrence of any adenoma. But with the follow-up greater than 2 years, oral aspirin had no effect in the white.

Keywords

Colorectal adenoma;aspirin;recurrence;meta-analysis

References

  1. Baron JA, Cole BF, Sandler RS, et al (2003). A randomized trial of aspirin to prevent colorectal adenomas. N Engl J Med, 348, 891-9. https://doi.org/10.1056/NEJMoa021735
  2. Benamouzig R, Deyra J, Martin A, et al (2003). Daily soluble aspirin and prevention of colorectal adenoma recurrence, one year results of the APACC trial. Gastroenterol, 125, 328-36. https://doi.org/10.1016/S0016-5085(03)00887-4
  3. Benamouzig R, Uzzan B, Deyra J, et al (2012). Prevention by daily soluble aspirin of colorectal adenoma recurrence, 4-year results of the APACC randomized trial. Gut, 61, 255-61. https://doi.org/10.1136/gutjnl-2011-300113
  4. Cole BF, Logan RF, Halabi S, et al (2009). Aspirin for the Chemoprevention of Colorectal Adenomas, Meta-analysis of the Randomized Trials. J Natl Cancer Inst, 101, 256-66. https://doi.org/10.1093/jnci/djn485
  5. Cotton S, Sharp L, Little J (1996). The adenoma-carcinoma sequence and prospects for the prevention of colorectal neoplasia. Crit Rev Oncog, 7, 293-342. https://doi.org/10.1615/CritRevOncog.v7.i5-6.10
  6. Ferlay J, Bray F, Pisani P, Parkin DM (2004). GLOBOCAN 2002, Cancer Incidence, Mortality and Prevalence Worldwide, IARC Cancer Base no.5, version 2.0. Lyon, IARC Press.
  7. Gao F, Liao C, Liu L, et al (2008). The effect of aspirin in the recurrence of colorectal adenomas, a meta-analysis of randomized controlled trials. Colorectal Disease, 11, 893-901.
  8. Grau MV, Sandler RS, Eyssen GM, et al (2009). Nonsteroidal anti-inflammatory drug use after 3 years of aspirin use and colorectal adenoma risk, observational follow-up of a randomized study. J Natl Cancer Inst, 101, 267-76. https://doi.org/10.1093/jnci/djn484
  9. Greving JP, Buskens E, Koffijberg H, Algra A (2008). Cost-effectiveness of aspirin treatment in the primary prevention of cardiovascular disease events in subgroups based on age, gender, and varying cardiovascular risk. Circulation, 117, 2875-83. https://doi.org/10.1161/CIRCULATIONAHA.107.735340
  10. Ishikawa H, Mutoh M, Suzuki S, et al (2014). The preventive effects of low-dose enteric-coated aspirin tablets on the development of colorectal tumours in Asian patients, a randomised trial. Gut, 0, 1-5.
  11. Itzkowitz SH (1996). Gastrointestinal adenomatous polyps. Semin Gastrointest Dis, 7, 105-16.
  12. Jadad AR, Moore RA, Carroll D, et al (1996). Assessing the quality of reports of randomized clinical trials, is blinding necessary? Control Clin Trials, 17, 1-12. https://doi.org/10.1016/0197-2456(95)00134-4
  13. Kjaergard LL, Villumsen J, Gluud C. (2001). Reported methodological quality and discrepancies between large and small randomized trials in meta-analyses. Ann Intern Med, 135, 982-9. https://doi.org/10.7326/0003-4819-135-11-200112040-00010
  14. Li ZY, Gu JL, Zeng Z, Shi W (2011). Clinical study of aspirin in the prevention of recurrence of colorectal adenoma in the elderly. Chinese J Med Guide, 13, 89.
  15. Logan RF, Grainge MJ, Shepherd VC et al. (2008). Aspirin and folic acid for the prevention of recurrent colorectal adenomas. Gastroenterol, 134, 29-38. https://doi.org/10.1053/j.gastro.2007.10.014
  16. Macarthur M, Hold GL, El-Omar EM (2004). Inflammation and Cancer II. Role of chronic inflammation and cytokinegene polymorphisms in the pathogenesis of gastrointestinal malignancy. Am J Physiol Gastrointest Liver Physiol, 286, 515-20. https://doi.org/10.1152/ajpgi.00475.2003
  17. Moher D, Pham B, Jones A, et al (1998). Does quality of reports of randomized trials affect estimates of intervention efficacy reported in meta-analyses? Lancet, 352, 609-13. https://doi.org/10.1016/S0140-6736(98)01085-X
  18. Neugut AI, Jacobson JS, De Vivo I (1993). Epidemiology of colorectal adenomatous polyps. Cancer Epidemiol Biomarkers Prev, 2, 159-76.
  19. Peipins LA, Sandler RS (1994). Epidemiology of colorectal adenomas. Epidemiol Rev, 16, 273-97. https://doi.org/10.1093/oxfordjournals.epirev.a036154
  20. Sandler RS, Halabi S, Baron JA, et al (2003). A randomized trial of aspirin to prevent colorectal adenomas in patients with previous colorectal cancer. New Engl J Med, 348, 883-90. https://doi.org/10.1056/NEJMoa021633
  21. Wang Y, Zhang FC, Wang YJ (2014). The efficacy and safety of non-steroidal anti-inflammatory drugs in preventing the recurrence of colorectal adenoma, a meta-analysis and systematic review of randomized trials. Colorectal Disease, 17, 188-96.
  22. Winawer SJ, Zauber AG, O'Brien MJ, et al (1993). Randomized comparison of surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps. The National Polyp Study Workgroup. N Engl J Med, 328, 901-6. https://doi.org/10.1056/NEJM199304013281301
  23. Zha S, Yegnasubramanian V, Nelson WG, Isaacs WB, De Marzo AM (2004). Cyclooxygenases in cancer, progress and perspective. Cancer Lett, 215, 1-20. https://doi.org/10.1016/j.canlet.2004.06.014