The effects of nonsteroidal anti-inflammatory drugs in the incident and recurrent risk of hepatocellular carcinoma: a meta-analysis

Abstract

BackgroundRecent studies have showed that nonsteroidal anti-inflammatory drugs (NSAIDs) could reduce the risk of several types of cancer. However, epidemiological evidence of the association between NSAIDs intake and the risk of hepatocellular carcinoma (HCC) remains controversial.MethodsTo assess the preventive benefit of NSAIDs in HCC, we simultaneously searched the databases of PubMed, EmBase, Web of Science, and Scopus and screened eligible publications.ResultsA total of twelve articles (published from 2000 to 2017) from five countries were identified by retrieval. We observed a significantly lower risk of HCC incidence among users of NSAIDs than among those who did not use NSAIDs (pooled hazard ratio [HR] value =0.81, 95% confidence interval [CI]: 0.69–0.94). No evidence of publication bias was observed (Begg’s test, P=0.755; Egger’s test, P=0.564). However, when stratified according to the categories of NSAIDs, users of non-aspirin NSAIDs (HR =0.81, 95% CI: 0.70–0.94), but not aspirin (HR =0.77, 95% CI: 0.58–1.02), showed a statistically significant reduced HCC incidence. We also found that NSAIDs use significantly reduced the recurrent risk of HCC, with a HR value of 0.79 (95% CI: 0.75–0.84), whereas there was no statistically significant association between NSAIDs use and HCC mortality, with a HR value 0.65 (95% CI: 0.40–1.06).ConclusionTaken together, our meta-analysis demonstrates that NSAIDs significantly reduce the incident and recurrent risk of HCC.

Metformin and risk of hepatocellular carcinoma in patients with type 2 diabetes

“…Although the effect of aspirin on HCC is not well established, 24 this study suggested a potential beneficial effect of aspirin and its interaction with metformin (Table 4).…”

“…Therefore, the potential confounding effect of statin and the interaction between metformin and statin should not be neglected. Although the effect of aspirin on HCC is not well established, this study suggested a potential beneficial effect of aspirin and its interaction with metformin (Table ).…”

Review article: the prevention of hepatitis B‐related hepatocellular carcinoma

“…Several nationwide cohort studies from Taiwan revealed that the use of concomitant medications with statin and nonsteroidal anti‐inflammatory drugs (NSAIDs) or aspirin could reduce the risk of HCC recurrence in patients receiving curative HCC resection, regardless of HBV status . Recently, a meta‐analysis including 12 studies also demonstrated that NSAIDs significantly reduced the recurrent risk of HCC (HR: 0.79, 95% CI: 0.75‐0.84) . The effects of non‐anti–viral medicine on reduction risk of HCC recurrence should be confirmed through prospective studies or randomised clinical trials.…”

Aspirin decreases hepatocellular carcinoma risk in hepatitis C virus carriers: a nationwide cohort study

“…It also plays an important role in preventing cerebrovascular and cardiovascular thrombosis and even lowering the associated mortality, especially in diabetes mellitus patients [7][8][9][10]. Aspirin may also prevent the occurrence of some cancers, such as colorectal cancer [11][12][13][14], lung cancer [15], prostate cancer [16], and head and neck cancer [17], as well as HCC [18]. Its effects are likely due to the inhibition of the cyclooxygenase enzyme.…”

“…Aspirin treatment can decrease the occurrence of HCC through the inhibition of the cyclooxygenase enzyme pathway. Some retrospective reports have shown that aspirin decreases the incidence of HCC [18,20]. However, the association between aspirin use and the incidence of HCC has been evaluated only in HBV carriers, not in HCV carriers [21].…”