The effect of aspirin and nonsteroidal anti-inflammatory drug use after diagnosis on survival of oesophageal cancer patients.
Aspirin use has been shown to lower incidence and mortality in cancer patients. The aim of this population-based study was to determine the effect of postdiagnosis low-dose aspirin use on survival of patients with oesophageal cancer.



Patients with oesophageal cancer (1998-2010) were selected from the Eindhoven Cancer Registry and linked with outpatient pharmacy data regarding aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs). Users were subdivided into both prediagnosis and postdiagnosis or only postdiagnosis users. Parametric survival models with an exponential (Poisson) distribution were used with non-specific death as endpoint.



In this study 560 patients were included. Overall, 157 patients (28.0%) were non-users, 293 patients (52.3%) pre- and postdiagnosis (89 aspirin and 204 NSAID users) and 110 patients (19.6%) only postdiagnosis users (16 aspirin and 94 NSAID users). Postdiagnosis aspirin use was associated with overall survival (RR 0.45 (95% CI 0.34-0.60; P<0.001); adjusted rate ratio was 0.42 (95% CI: 0.30-0.57; P<0.001). Postdiagnosis use of NSAIDs was associated with overall survival (RR 0.61 (95% CI 0.49-0.76; <0.001); however, adjusted analyses did not show a significant association with a rate ratio of 0.84 (95% CI 0.66-1.07; P=0.2).



Our study shows that postdiagnosis aspirin use might be associated with a higher survival rate in oesophageal cancer patients. A randomised clinical trial is needed to verify our observations of possible postdiagnosis aspirin use benefit.
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Jente
J
van Staalduinen
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Martine
M
Frouws
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Marlies
M
Reimers
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.|Department of Gerontology & Geriatrics, Leiden University Medical Center, Leiden, The Netherlands.
Esther
E
Bastiaannet
PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands.
Myrthe P P
MP
van Herk-Sukel
Department of Research, Comprehensive Cancer Centre Netherlands, Eindhoven, The Netherlands.|Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.
Valery
V
Lemmens
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Wobbe O
WO
de Steur
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Henk H
HH
Hartgrink
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Cornelis J H
CJ
van de Velde
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Gerrit-Jan
GJ
Liefers
D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000401:mortality; D005260:Female; D006801:Humans; D008875:Middle Aged; D018570:Risk Assessment; D015996:Survival Rate
D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin