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Does aspirin reduce the incidence, recurrence, and mortality of colorectal cancer? A meta-analysis of randomized clinical trials

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

Colorectal cancer (CRC) is the third most common diagnosed cancer and the third leading cause of all cancer deaths in the USA. Some evidences are shown that aspirin can reduce the morbidity and mortality of different cancers, including CRC. Aspirin has become a new focus of cancer prevention and treatment research so far; clinical studies, however, found conflicting conclusions of its anti-cancer characteristics. This study is to summarize the latest evidence of correlation between aspirin use and CRC and/or colorectal adenomas.

Methods

Databases were searched to identify randomized controlled trials (RCTs) in the salvage setting. The pooled relative risk (RR) with 95% confidence interval (CI) was used to estimate the effect of aspirin on colorectal cancer and/or colorectal adenomas. Subgroup analysis and sensitivity analysis were also conducted.

Results

The result showed that aspirin use was not associated with incidence of CRC (RR 0.97; 95% CI 0.84–1.12; P = 0.66; I2 = 34%), aspirin use was found to be associated with reduced recurrence of colorectal adenomas (RR 0.83; 95% CI 0.72–0.95; P = 0.006; I2 = 63%) and reduced mortality of CRC (RR 0.79; 95% CI 0.64–0.97; P = 0.02; I2 = 14%). Subgroup analysis found a statistically significant association in low dose with a pooled RR of 0.85 (95% CI 0.74–0.99; P = 0.03; I2 = 31%).

Conclusions

This meta-analysis of randomized controlled trial data indicates that aspirin reduces the overall risk of recurrence and mortality of CRC and/or colorectal adenomas. Incidence of CRC was also reduced with low-dose aspirin. The emerging evidence on aspirin’s cancer protection role highlights an exciting time for cancer prevention through low-cost interventions.

Trial registration

Clinicaltrials.gov no: CRD42020208852; August 18, 2020; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020208852).

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Acknowledgements

We appreciate all authors for their contributions, and support from AMITA Health Saint Joseph Hospital Chicago and Anhui Medical University.

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All data generated or analyzed during this study was taken from published RCTs and are included in this published article (and its supplementary information files).

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  1. Shaodi Ma and Tiantian Han contributed equally to this work.

Authors and Affiliations

  1. Department of Epidemiology and Health Statistics, School of Public Health Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, People’s Republic of China

    Shaodi Ma, Tiantian Han, Huimei Zhang & Guangbo Qu

  2. AMITA Health Saint Joseph Hospital Chicago, 2900 N. Lake Shore Drive, Chicago, IL, 60657, USA

    Chenyu Sun & Chandur Bhan

  3. The University of Arizona College of Medicine at South Campus, 2800 E Ajo Way, Tucson, AZ, 85713, USA

    Ce Cheng

  4. Massachusetts College of Pharmacy and Health Sciences, 179 Longwood Ave, Boston, MA, 02115, USA

    Hongru Yang, Zhichun Guo, Yue Yan, Chenyu Cao & Ziwei Ji

  5. Radiation Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Qin Zhou

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Contributions

Shaodi Ma and Dr. Chenyu Sun designed research; Shaodi Ma, Tiantian Han, and Huimei Zhang conducted literature search; Shaodi Ma, Guangbo Qu, and Dr. Chenyu Sun analyzed data; and Shaodi Ma and Dr. Chenyu Sun wrote the paper. Dr. Chenyu Sun, Dr. Ce Cheng, Dr. Chandur Bhan, and Dr. Qin Zhou provided critical opinion. Dr. Chenyu Sun, Dr. Ce Cheng, Hongru Yang, Zhichun Guo, Yue Yan, Chenyu Cao, Ziwei Ji, and Dr. Qin Zhou revised the paper. Shaodi Ma and Tiantian Han had primary responsibility for final content. Dr. Chenyu Sun is the corresponding author. All authors read and approved the final manuscript.

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Correspondence to Chenyu Sun.

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This article does not contain any studies with human participants or animals performed by any of the authors. We did not use individual data but published data. These data have been widely utilized in research and are generally available. Therefore, we confirm that any aspect of the work covered in this manuscript has been conducted with ethical approval. And this study has been registered (registration number: CRD42015025849) with the PROSPERO (International Prospective Register of Systematic Reviews) and was conducted according to the Preferred Reporting Items for Systemic Reviews and Meta-Analysis (PRISMA) statement.

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Ma, S., Han, T., Sun, C. et al. Does aspirin reduce the incidence, recurrence, and mortality of colorectal cancer? A meta-analysis of randomized clinical trials. Int J Colorectal Dis 36, 1653–1666 (2021). https://doi.org/10.1007/s00384-021-03889-8

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