结直肠癌患者长期口服低剂量阿司匹林与预后关系的Meta分析

Association of long-term oral low-dose aspirin and survival in colorectal cancer：a meta-analysis

目的：探讨结直肠癌患者长期口服低剂量阿司匹林与预后的关系。方法检索2014年6月前，Pubmed、Embase、Cochrane Library、Web of Science、中国生物医学文献数据库、中国期刊全文数据库和万方数据库公开发表的结直肠癌患者确诊后长期口服低剂量阿司匹林是否改善预后的临床试验文献。通过纳入和排除标准筛选后采用Newcastle-Ottawa Scale量表进行质量评分，采用State 12．0软件对所纳入的数据行Meta分析。结果共纳入8篇文献的28103例患者，入选文献的质量均为6分以上。Meta分析结果显示，各研究间存在异质性（I2＝78．2％，P＜0．01）；确诊为结直肠癌后，患者长期口服低剂量阿司匹林可能是改善预后的一个独立性保护因素（HR＝0．732，95％ CI：0．613～0．875，P＜0．01）。分别对7篇研究设计相同的文献以及6篇Ⅰ～Ⅳ期肿瘤分期的文献进行敏感性分析，结果显示，敏感性低，结果较为稳定（分别为HR＝0．687，95％ CI：0．557～0．849，P＜0．01；HR＝0．682，95％ CI：0．539～0．864，P＜0．01）。结论长期口服低剂量阿司匹林可能有助于改善结直肠癌患者预后。

Objective To examine the association between long-term oral low-dose aspirin and overall survival in colorectal cancer patients after diagnosis. Methods The literature databases, such as PubMed, Embase, Cochrane Library, Web of Science, CBM, CNKI, and Wanfang database, were extensively searched to retrieve the comparative studies about the association between low-dose aspirin use after colorectal cancer diagnosis and overall survival published before June 2014. The state 12.0 version software was used for meta-analysis. The quality of these studies was assessed using the Newcastle-Ottawa scale. Results There were eight studies meeting the inclusion criteria for meta-analysis. The total sample size of these studies included 28 103 cases and the score of all the studies was more than 6 points. Meta-analysis of the data using I2 test showed significant heterogeneity （I2=78.2%, P〈0.01）, therefore, a random effect model was performed. Aspirin use after diagnosis was associated with longer overall survival （HR=0.732, 95% CI：0.613-0.875, P〈0.01）. There were seven studies with the same design or tumor stage inⅠ-Ⅳ period respectively for sensitivity analysis. The results of studies showed that the sensitivity was low and accurate （HR=0.687, 95% CI： 0.557-0.849, P〈0.01; HR=0.682, 95% CI： 0.539-0.864, P〈0.01）. Conclusion Meta-analysis shows that long-term oral low-dose aspirin after diagnosis of colorectal cancer is identified as a significant prognostic factor.