Daily soluble aspirin and prevention of colorectal adenoma recurrence: one-year results of the APACC trial.
OBJECTIVE
Epidemiologic and experimental studies have suggested that aspirin intake reduces the risk for colorectal carcinogenesis. However, the available data are not sufficient to serve as the basis for firm recommendations.


METHODS
We randomly assigned 272 patients with a history of colorectal adenomas (at least one more than 5 mm in diameter, or more than 3) to daily lysine acetylsalicylate (160 or 300 mg/day) or placebo for 4 years. The primary end points were adenoma recurrence after 1 and 4 years. These results are those of the year 1 colonoscopy.


RESULTS
Among the 238 patients who completed the year 1 colonoscopy, at least one adenoma was observed in 38 patients of the 126 (30%) in the aspirin group and in 46 of the 112 (41%) in the placebo group; relative risk was 0.73 (95% confidence interval [CI]: 0.52-1.04; P = 0.08). At least one adenoma of more than 5 mm diameter was observed in 13 patients (10%) in the aspirin group and 26 (23%) in the placebo group (P = 0.01). The corresponding numbers for adenomas more than 10 mm in diameter were one (1%) and 7 (6%) (P = 0.05). Stepwise regression showed that independent factors associated with lower adenoma recurrence are aspirin treatment (adenoma >5 mm, P = 0.01), absence of personal history of adenoma before the entry colonoscopy (P = 0.01), and initial adenomatous polyp burden less than 10 mm (P = 0.001).


CONCLUSIONS
Daily soluble aspirin is associated with a reduction in the risk for recurrent adenomas found at colonoscopy 1 year after starting treatment.
Benamouzig
Robert
R
Department of Gastroenterology, Avicenne Hospital, AP-HP, Paris 13 University, Bobigny Cedex, France.
Deyra
Jacques
J
Martin
Antoine
A
Girard
Bernard
B
Jullian
Eric
E
Piednoir
Benoit
B
Couturier
Daniel
D
Coste
Thierry
T
Little
Julian
J
Chaussade
Stanislas
S
D000236:Adenoma / Q000517:prevention & control*; D001241:Aspirin / Q000008:administration & dosage*; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D010349:Patient Compliance
D001241:Aspirin