【文摘发布】阿斯匹林与结直肠癌的风险与COX-2的表达相关

【文摘发布】阿斯匹林与结直肠癌的风险与COX-2的表达相关

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RESOURCE: NEJM,olume 356:2131-2142 May 24, 2007 Number 21

TITLE: Aspirin and the Risk of Colorectal Cancer in Relation to the Expression of COX-2
标题： 阿斯匹林与结直肠癌的风险与COX-2的表达相关

AUTHOR: Andrew T. Chan, M.D., M.P.H., Shuji Ogino, M.D., Ph.D., and Charles S. Fuchs, M.D., M.P.H.

ABSTRACT
摘要

Background Regular use of aspirin reduces the risk of a colorectal neoplasm, but the mechanism by which aspirin affects carcinogenesis in the colon is not well understood.
研究背景：定期服用阿斯匹林降低结直肠癌的风险，但是阿斯匹林影响肠道致癌作用的机制并不是很清楚。

Methods We estimated cyclooxygenase-2 (COX-2) expression by immunohistochemical assay of sections from paraffin-embedded colorectal-cancer specimens from two large cohorts of participants who proided data on aspirin use from a questionnaire eery 2 years. We applied Cox regression to a competing-risks analysis to compare the effects of aspirin use on the relatie risk of colorectal cancer in relation to the expression of COX-2 in the tumor.
方法：口服阿斯匹林的相关资料来自两个大型队列研究中参与者每2年1次的调查表，利用免疫组化法评估参与者结直肠癌石蜡包埋标本切片的环氧化酶-2（COX-2）的表达。应用竞争风险Cox回归分析比较口服阿斯匹林对结直肠癌与肿瘤COX-2的表达相关的相对危险度的影响

Results During 2,446,431 person-years of follow-up of 82,911 women and 47,363 men, we found 636 incident colorectal cancers that were accessible for determination of COX-2 expression. Of the tumors, 423 (67%) had moderate or strong COX-2 expression. The effect of aspirin use differed significantly in relation to COX-2 expression (P for heterogeneity=0.02). Regular aspirin use conferred a significant reduction in the risk of colorectal cancers that oerexpressed COX-2 (multiariate relatie risk, 0.64; 95% confidence interal [CI], 0.52 to 0.78), whereas regular aspirin use had no influence on tumors with weak or absent expression of COX-2 (multiariate relatie risk, 0.96; 95% CI, 0.73 to 1.26). The age-standardized incidence rate for cancers that oerexpressed COX-2 was 37 per 100,000 person-years among regular aspirin users, as compared with 56 per 100,000 person-years among those who did not use aspirin regularly; in contrast, the rate for cancers with weak or absent COX-2 expression was 27 per 100,000 person-years among regular aspirin users, as compared with 28 per 100,000 person-years among nonregular aspirin users.
结果：在2,446,431人年数随访期间，女82,911例、男47,363例, 共636例结直肠癌可用来检测COX-2的表达，其中423例 (67%) 有中度或强度COX-2的表达。口服阿斯匹林的效果因COX-2的表达程度而存在显著差别 (变异性P =0.02). 定期口服阿斯匹林使过度表达COX-2的结直肠癌显著减少了(多变量相对危险度= 0.64; 95% 可信区间[CI]0.52-0.78), 与之相比，对COX-2弱表达或无表达的肿瘤无影响(多变量相对危险度0.96; 95% CI0.73-1.26)。参与者经年龄标化后，COX-2过度表达的结直肠癌的发病率，定期口服阿斯匹林为37/10万人年，而未定期口服阿斯匹林为56/10万人年；与之相比，COX-2弱或无表达的结直肠癌的发病率，定期口服阿斯匹林为27/10万人年，而未定期口服阿斯匹林的为28/10万人年。

Conclusions Regular use of aspirin appears to reduce the risk of colorectal cancers that oerexpress COX-2 but not the risk of colorectal cancers with weak or absent expression of COX-2.
结论：定期口服阿斯匹林显示能降低COX-2过度表达的结直肠癌的风险，但不能降低COX-2弱或无表达的结直肠癌的风险。

全文编译：（574字）

阿斯匹林与结直肠癌的风险与COX-2的表达相关
定期服用阿斯匹林能够降低结直肠癌的风险，但是阿斯匹林影响肠道致癌作用的机制并不是很清楚，基于这一研究背景，Andrew T. Chan等人在2007年5月24日《新英格兰杂志》网络版上发表的一篇研究显示阿斯匹林降低结直肠癌的风险与COX-2的表达相关。

该研究的口服阿斯匹林的相关资料来自两个大型队列研究中参与者每2年1次的调查表，利用免疫组化法评估参与者结直肠癌石蜡包埋标本切片的环氧化酶-2（COX-2）的表达。应用竞争风险Cox回归分析比较口服阿斯匹林对结直肠癌与肿瘤COX-2的表达相关的相对危险度的影响。研究结果显示：在2,446,431人年数随访期间，女82,911例、男47,363例, 共636例结直肠癌可用来检测COX-2的表达，其中423例 (67%) 有中度或强度COX-2的表达。口服阿斯匹林的效果因COX-2的表达程度而存在显著差别 (变异性P =0.02). 定期口服阿斯匹林使过度表达COX-2的结直肠癌显著减少了(多变量相对危险度= 0.64; 95% 可信区间[CI]0.52-0.78), 与之相比，对COX-2弱表达或无表达的肿瘤无影响(多变量相对危险度0.96; 95% CI0.73-1.26)。参与者经年龄标化后，COX-2过度表达的结直肠癌的发病率，定期口服阿斯匹林为37/10万人年，而未定期口服阿斯匹林为56/10万人年；与之相比，COX-2弱或无表达的结直肠癌的发病率，定期口服阿斯匹林为27/10万人年，而未定期口服阿斯匹林的为28/10万人年。

基于上述结果，研究者得出结论认为定期口服阿斯匹林能降低COX-2过度表达的结直肠癌的风险，但不能降低COX-2弱或无表达的结直肠癌的风险。