000075817 001__ 75817
000075817 005__ 20200117212654.0
000075817 0247_ $$2doi$$a10.1371/journal.pone.0203957
000075817 0248_ $$2sideral$$a108526
000075817 037__ $$aART-2018-108526
000075817 041__ $$aeng
000075817 100__ $$aElwood, P.C.
000075817 245__ $$aSystematic review update of observational studies further supports aspirin role in cancer treatment: Time to share evidence and decision-making with patients?
000075817 260__ $$c2018
000075817 5060_ $$aAccess copy available to the general public$$fUnrestricted
000075817 5203_ $$aBackground
Evidence is growing that low-dose aspirin used as an adjuvant treatment of cancer is associated with an increased survival and a reduction in metastatic spread. We therefore extended up to August 2017 an earlier systematic search and meta-analyses of published studies of low-dose aspirin taken by patients with a diagnosis of cancer.
Methods
Searches were completed in Medline and Embase to August 2017 using a pre-defined search strategy to identify reports of relevant studies. References in all the selected papers were scanned. Two reviewers independently applied pre-determined eligibility criteria and extracted data on cause-specific cancer deaths, overall mortality and the occurrence of metastatic spread. Meta-analyses were then conducted for different cancers and heterogeneity and publication bias assessed. Sensitivity analyses and attempts to reduce heterogeneity were conducted.
Results
Analyses of 29 studies reported since an earlier review up to April 2015 are presented in this report, and these are then pooled with the 42 studies in our earlier publication. Overall metaanalyses of the 71 studies are presented, based on a total of over 120 thousand patients taking aspirin. Ten of the studies also give evidence on the incidence of metastatic cancer spread. There are now twenty-nine observational studies describing colorectal cancer (CRC) and post-diagnostic aspirin. Pooling the estimates of reduction by aspirin which are reported as hazard ratios (HR), gives an overall HR for aspirin and CRC mortality 0.72(95% CI 0.64-0.80). Fourteen observational studies have reported on aspirin and breast cancer mortality and pooling those that report the association with aspirin as a hazard ratio gives HR 0.69 (0.53-0.90). Sixteen studies report on aspirin and prostate cancer mortality and a pooled estimate yields an HR of 0.87 (95% CI 0.73-1.05). Data from 12 reports relating to other cancers are also listed. Ten studies give evidence of a reduction in metastatic spread; four give a pooled HR 0.31 (95% CI 0.18, 0.54) and five studies which reported odds ratio of metastatic spread give OR 0.79 (0.66 to 0.95).
Conclusion
Being almost entirely from observational studies, the evidence of benefit from aspirin is limited. There is heterogeneity between studies and the results are subject to important biases, only some of which can be identified. Nevertheless, the evidence would seem to merit wide discussion regarding whether or not it is adequate to justify the recommendation of low-dose therapeutic aspirin, and if it is, for which cancers?
000075817 540__ $$9info:eu-repo/semantics/openAccess$$aby$$uhttp://creativecommons.org/licenses/by/3.0/es/
000075817 590__ $$a2.776$$b2018
000075817 591__ $$aMULTIDISCIPLINARY SCIENCES$$b23 / 69 = 0.333$$c2018$$dQ2$$eT2
000075817 592__ $$a1.1$$b2018
000075817 593__ $$aAgricultural and Biological Sciences (miscellaneous)$$c2018$$dQ1
000075817 593__ $$aMedicine (miscellaneous)$$c2018$$dQ1
000075817 593__ $$aBiochemistry, Genetics and Molecular Biology (miscellaneous)$$c2018$$dQ1
000075817 655_4 $$ainfo:eu-repo/semantics/review$$vinfo:eu-repo/semantics/publishedVersion
000075817 700__ $$aPickering, J.E.
000075817 700__ $$aMorgan, G.
000075817 700__ $$aGalante, J.
000075817 700__ $$aWeightman, A.L.
000075817 700__ $$aMorriss, D.
000075817 700__ $$aLongley, M.
000075817 700__ $$aMason, M.
000075817 700__ $$aAdame, R.
000075817 700__ $$aDolwani, S.
000075817 700__ $$aChia, W.K.J.
000075817 700__ $$0(orcid)0000-0001-5932-2889$$aLanas, A.$$uUniversidad de Zaragoza
000075817 7102_ $$11007$$2610$$aUniversidad de Zaragoza$$bDpto. Medicina, Psiqu. y Derm.$$cArea Medicina
000075817 773__ $$g13, 9 (2018), e0203957[17 pp]$$pPLoS One$$tPloS one$$x1932-6203
000075817 8564_ $$s361774$$uhttps://zaguan.unizar.es/record/75817/files/texto_completo.pdf$$yVersión publicada
000075817 8564_ $$s77468$$uhttps://zaguan.unizar.es/record/75817/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada
000075817 909CO $$ooai:zaguan.unizar.es:75817$$particulos$$pdriver
000075817 951__ $$a2020-01-17-21:22:01
000075817 980__ $$aARTICLE