Effect Of Long Term Prediagnostic Aspirin Use On The Prognosis Of Esophageal Squamous Cell Carcinoma

Background:Esophageal cancer is a major health problem all over the world.Esophageal cancer is the top 10 most frequently cause of cancer death in both male and female causing more than 400,000 deaths in the worldwide in 2012.In China,esophageal cancer turned out to be the top 10 most commonly diagnosed cancer in both men and women(3rd in men and 6th in women).Different from the western country,esophageal squamous cell carcinoma(ESCC)is the major type and accounts for more than 90%of esophageal cancer in China.The effective preventive methods and prognostic indicators are quite needed for ESCC.Aspirin is an analgesic and antipyretic agent which is widely used.Studies have indicated aspirin may reduce the incidence and mortality of certain cancers.The anti-tumor mechanisms of aspirin include COX(Cyclooxygenase)dependent and COX independent pathways through inhibition of angiogenesis,autophagy,induction of apoptosis,anti-proliferative activity,and inhibition of metastasis.U.S.Preventive Services Task Force has recommended aspirin as a primary preventive agent of cardiovascular disease and colorectal cancer in adults in June 2016.Many studies have suggested that aspirin has a protective effect on several cancers.In despite of the large amount of the research between different cancers and aspirin use,the relationship between aspirin use and ESCC is still unclear.Object:This study provided a systematic investigation in the effect of long term prediagnostic aspirin use on the prognosis of ESCC patients who had received radical surgery for the first treatment.Material:The characteristics of patient,tumor,treatment methods and the final outcome were retrieved from the Medical Records Room or by phone call follow-up.During the first 2 years after surgery,follow-up visits were performed every 3 months.After that follow-up visits were performed every 6 months up to death or the end of the study(29 November 2016).Routine radiological examinations,such as X-ray barium meal and chest computed tomography,were performed when necessary.Methods:From 1 January 2010 to 31 December 2014,110 eligible ESCC patients who received radical surgery for primary treatment in Qilu hospital of Shandong University were enrolled in this study.37 patients who had used aspirin regularly for more than 3 months before diagnose and surgery were classified as aspirin group and 73 patients who had never used aspirin before diagnose and surgery were served as non-aspirin group.We compared the recurrence rate,mortality,disease-free survival(DFS)and over-all survival(OS)between the two groups.Results:The patient-related characteristics and tumor-related characteristics were not significantly different between the aspirin users and non-aspirin patients except cardiovascular complications.DFS decreased significantly in aspirin group than non-aspirin group in both univariate survival analysis and multivariate survival analysis(P<0.001,P=0.008,respectively).OS also decreased significantly in aspirin group in both univariate and multivariate survival analysis(P=0.017,P=0.027,respectively).Conclusions:Long term prediagnostic aspirin use may cause poor outcome of ESCC patients who received radical surgery for the first treatment.Long term prediagnostic aspirin use decreased DFS and OS of ESCC patients significantly.