Intervention Review

Non steroidal anti-inflammatory drugs (NSAID) and aspirin for preventing colorectal adenomas and carcinomas

  1. Tracey K. Asano1,*,
  2. Robin S McLeod2

Editorial Group: Cochrane Colorectal Cancer Group

Published Online: 8 OCT 2008

Assessed as up-to-date: 16 NOV 2003

DOI: 10.1002/14651858.CD004079.pub2

Database Title

Additional Information

How to Cite

Asano TK, McLeod RS. Non steroidal anti-inflammatory drugs (NSAID) and aspirin for preventing colorectal adenomas and carcinomas. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD004079. DOI: 10.1002/14651858.CD004079.pub2.

Author Information

  1. 1

    University of Toronto, Surgery, Toronto, ONT, Canada

  2. 2

    Mount Sinai Hospital, Division of General Surgery, Toronto, Ontario, Canada

*Tracey K. Asano, Surgery, University of Toronto, c/o Dr. Robin McLeod, 600 University Ave Suite 449, Toronto, ONT, M5G 1X5, Canada. tasano@mtsinai.on.ca.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 8 OCT 2008

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

There is evidence from experimental animals studies, prospective and retrospective observational studies that nonsteroidal anti-inflammatory drugs (NSAIDS) may reduce the development of sporadic colorectal adenomas (CRAs) and cancer (CRC) and may induce the regression of adenomas in familial adenomatous polyposis (FAP).

Objectives

To conduct a systematic review to determine the effect of NSAIDS for the prevention or regression of CRAs and CRC.

Search methods

Randomized controlled trials (RCTs) up to September 2003 were identified.

Selection criteria

NSAIDS and aspirin (ASA) were the interventions. The primary outcomes were the number of subjects with at least one CRA, the change in polyp burden, and CRC. The secondary outcome was adverse events.

Data collection and analysis

Two reviewers independently extracted data and assessed trial quality. Dichotomous outcomes were reported as relative risks (RR) with 95% confidence intervals (CI). The data were combined with the random effects model if clinically and statistically reasonable.

Main results

Nine trials with 150 familial adenomatous polyposis (FAP) and 24,143 population subjects met the inclusion criteria. The interventions included sulindac, celecoxib, or aspirin (ASA). From the combined results of three trials, significantly fewer subjects in the low dose ASA group developed recurrent sporadic CRAs [RR 0.77 (95% CI 0.61, 0.96), (NNT 12.5 (95% CI 7.7, 25)] after one to three years. In another three trials, phenotypic FAP subjects that received sulindac or celecoxib had a greater proportional reduction (range: 11.9% to 44%) in the number of CRAs compared to those in the control group (range: 4.5% to 10%). There was no significant difference for the outcomes of CRC or adverse events in any of the trials.

Authors' conclusions

There was evidence from three pooled RCTs that ASA significantly reduces the recurrence of sporadic adenomatous polyps after one to three years. There is evidence from short-term studies to support regression, but not elimination or prevention of CRAs in FAP.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Colorectal (bowel) cancer is common worldwide but is especially prevalent in industrialised countries. Genes, diet and lifestyle all seem to be important in the development of bowel cancer.

Experimental animals studies and observational studies have suggested that nonsteroidal anti-inflammatory drugs and aspirin may reduce the development of colorectal cancer and recurrence of adenomas in patients with familial adenomatous polyposis (FAP).

The review found some evidence to support the effectiveness of aspirin for reducing the risk of recurrent sporadic colorectal adenomas. Further, there is evidence from short-term studies to support regression, but not elimination or prevention of colorectal adenomas in FAP with NSAIDs.
The review suggests more research on the long-term role of NSAIDs.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

非類固醇抗發炎藥物(Non steroidal antiinflammatory drugs，NSAID)和阿斯匹靈對於預防大腸腺瘤(colorectal adenomas)和大腸癌(colorectal carcinomas)的影響

有一些由動物試驗、前瞻性觀察研究(prospective observational study)和回溯性觀察研究(retrospective observational study)所獲得的證據顯示，NSAID可能可以降低偶發性大腸腺瘤(sporadic colorectal adenomas ，CRAs)和大腸癌(colorectal cancer，CRC)的發生率，也可能會使遺傳性大腸息肉症(Familial adenomatous polyposis，FAP)的腺瘤產生退化

目標

本研究的主要目的在於建構一個系統性的觀點，以決定NSAIDS對於CRA和CRC的預防及復原的影響

搜尋策略

2003年月以前的RCT試驗都會接受確認

選擇標準

NSAIDS和阿斯匹靈(ASA)都是一種介入治療方法，主要的試驗成果為至少患有CRA的受試者人數、息肉負荷(polyp burden)的改變、和CRC的改變。次要試驗成果則是不良事件(副作用)

資料收集與分析

有2個審閱者分別獨立將數據萃取出並且評估試驗品質，二元化的試驗果會以相對風險(RR值)和95％的信心區間數值進行表示，在臨床上和統計上可理解的範圍內將數據與隨機效應模式進行合併

主要結論

九個含有150名FAP患者和24143個受試者的試驗被納入研究中，介入性治療包括使用sulindac、celecoxib和ASA，由3個試驗綜合的結果顯示，在接受治療1至3年後，使用低劑量ASA的組別中有明顯少數的患者引發復發性偶發CRA(RR值為0.77，95％的信心區間介於0.61至0.96之間，需要進行治療的人數為12.5人[95％的信心區間介於7.7至25之間])，在其他3個試驗中，表現型FAP患者接受sulindac或celecoxib進行治療後，復發的機率大幅度成比例的降低(由11.9％至44％)在這些試驗中，CRC的成果及副作用沒有顯著差異

作者結論

由這三個聚集性的RCT試驗得到的證據顯示，在接受ASA治療的組別在接受治療的1至3年間，偶發性大腸息肉的復發率有明顯的降低趨勢，由短期性的試驗來可以支持其對腫瘤衰退的效用，但是無法消除或預防FAP組中的CRA發生

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

大腸癌是一種普遍性的疾病，但是在工業國家又特別的盛行，基因、飲食和生活習慣似乎都對大腸癌的發生十分重要，動物實驗和觀察實驗都認為非類固醇性的抗發炎藥物和阿斯匹靈可能可以降低FAP患者身上大腸癌的發生和腺瘤的復發的機率，本研究發現一些證據可以支持阿斯匹靈對於降低偶發性大腸癌風險的效用，此外，由短期性的實驗也可以推測其對大腸腺瘤的退化，但是對於使用NSAIDS的FAP患者，無法消除或預防大腸腺瘤。本研究認為需要進行更多研究來瞭解NSAIDS對於長期治療所扮演的角色

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