title: Nonsteroidal anti-inflammatory drugs are associated with reduced risk of early hepatocellular carcinoma recurrence after curative liver resection: a nationwide cohort study.
abstract: OBJECTIVE
  The efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) in reducing the risk of various de novo cancers has been reported; however, its role in reducing hepatocellular carcinoma (HCC) recurrence after liver resection still remains unknown.
  
  
  METHODS
  We have conducted a nationwide cohort study by recruiting all patients with a newly diagnosed HCC who had received curative liver resection as their initial treatment. The use of NSAIDs and the risk of early HCC recurrence have been examined by multivariate and stratified analyses. To avoid immortal time bias, the use of NSAIDs has been treated as a time-dependent variable in Cox proportional hazard ratio models.
  
  
  RESULTS
  Between January 1997 and December 2010, a total of 15,574 HCC patients who had received liver resection were enrolled in this study. The 1-, 3-, and 5-year overall survival rates were 90.4%, 73.2%, and 59.8%, respectively. The 1-, 3-, and 5-year disease-free survival rates were 80.5%, 59.4%, and 50.2%, respectively. NSAID use (hazard ratio, 0.81; 95% confidence interval, 0.73-0.90) and minor liver resection (hazard ratio, 0.83; 95% confidence interval, 0.78-0.89) were independently associated with a reduced risk of early HCC recurrence after liver resection. In the stratified analyses, NSAID usage was universally associated with reduced risks in most subgroups, particularly for those aged younger than 65 years, male, with underlying diabetes mellitus and receiving major liver resection.
  
  
  CONCLUSIONS
  The use of NSAIDs can be associated with a reduced risk of early HCC recurrence within 2 years after curative liver resection, regardless of patients' age, extent of liver resection, viral hepatitis status, underlying diabetes, and liver cirrhosis.
authors.affiliation: *Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan †Department of Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan ‡School of Medicine, China Medical University, Taichung, Taiwan §School of Medicine, Fu Jen Catholic University, Taipei, Taiwan ¶Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan ‖Center for Health Policy Research and Development, National Health Research Institutes, Miaoli, Taiwan **Division of Gastroenterology, National Taiwan University Hospital, Taipei, Taiwan ††Center for Evidence-Based Medicine Taipei Medical University, Taipei, Taiwan ‡‡Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan §§Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan ¶¶Department of Public Health, China Medical University, Taichung, Taiwan; and ‖‖Department of Life Sciences, National Chung-Hsing University, Taichung, Taiwan.
authors.forename: Chun-Chieh
authors.initials: CC
authors.lastname: Yeh
authors.forename: Jaw-Town
authors.initials: JT
authors.lastname: Lin
authors.forename: Long-Bin
authors.initials: LB
authors.lastname: Jeng
authors.forename: Hsiu J
authors.initials: HJ
authors.lastname: Ho
authors.forename: Horng-Ren
authors.initials: HR
authors.lastname: Yang
authors.forename: Ming-Shiang
authors.initials: MS
authors.lastname: Wu
authors.forename: Ken N
authors.initials: KN
authors.lastname: Kuo
authors.forename: Chun-Ying
authors.initials: CY
authors.lastname: Wu
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D012737:Sex Factors; D015996:Survival Rate; D013624:Taiwan
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal