Prediagnosis aspirin use and outcomes in a prospective cohort of esophageal cancer patients.
BACKGROUND
Esophageal cancer remains associated with poor outcomes, yet little is known regarding factors that influence survival. Aspirin use prior to cancer diagnosis may influence outcomes. We aimed to assess the effects of prediagnosis aspirin use in patients with esophageal cancer.


METHODS
We conducted a prospective cohort study of newly-diagnosed esophageal cancer patients at two tertiary care centers. We assessed history of prediagnosis aspirin use, and prospectively followed patients and assessed mortality, cause of death, and development of metastases.


RESULTS
We enrolled 130 patients, the majority of whom were male (81.5%) and had adenocarcinoma (80.8%). Overall, 57 patients (43.9%) were regular aspirin users. In unadjusted analyses, we found no difference in all-cause mortality between aspirin users and nonusers. In multivariate analyses, prediagnosis aspirin use was not associated with all-cause mortality [hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.48-1.57] or esophageal cancer-specific mortality (HR 1.07, 95% CI 0.52-2.21). Prediagnosis aspirin use was associated with a significantly increased risk of interval metastasis (HR 3.59, 95% CI 1.08-11.96).


CONCLUSIONS
In our cohort of esophageal cancer patients, prediagnosis aspirin use was not associated with all-cause or cancer-specific mortality. However, risk of interval metastatic disease was increased among those who took aspirin regularly prediagnosis. Future studies are warranted to assess whether aspirin influences the molecular characteristics of esophageal tumors, with potential prognostic and therapeutic implications.
Department of Medicine, Columbia University Medical Center, New York, NY, USA.
James L
JL
Araujo
Department of Thoracic Surgery, Weill Cornell Medical Center, New York, NY, USA.
Nasser K
NK
Altorki
Department of Thoracic Surgery, Columbia University Medical Center, New York, NY, USA.
Joshua R
JR
Sonett
Department of Medicine, Columbia University Medical Center, New York, NY, USA.
Adriana
A
Rodriguez
Department of Thoracic Surgery, Columbia University Medical Center, New York, NY, USA.
Kivilcim
K
Sungur-Stasik
Department of Thoracic Surgery, Weill Cornell Medical Center, New York, NY, USA.
Cathy F
CF
Spinelli
Department of Medicine, Columbia University Medical Center, New York, NY, USA.
Alfred I
AI
Neugut
Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Medical Center, 622 W 168th Street, PH 7W-318, New York, NY 10032, USA.
Julian A
JA
Abrams
aspirin; epidemiology; esophageal cancer; metastasis; survival