Aspirin reduces risk for HCC in chronic hepatitis B
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For patients with chronic hepatitis B, aspirin therapy correlated with a reduced risk for hepatocellular carcinoma, according to a presenter at The Liver Meeting Digital Experience.
“Cirrhosis had a significant effect on the association between use of aspirin and the risk of HCC development,” Heejoon Jang, MD, from the department of internal medicine and Liver Research Institute, Seoul National University Hospital, said during his presentation.
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Using the Korean National Health insurance database, Jang and colleagues identified 329,635 adult patients with chronic hepatitis B; 20,200 of whom received aspirin for 90 or more consecutive days and 309,435 who never received antiplatelet therapy. To balance baseline characteristics between aspirin users and nonusers, investigators developed a propensity score-matched cohort. Researchers then estimated risk for HCC development.
Propensity score matching analysis generated 19,003 pairs. Median follow-up was 6.7 years.
Results showed the cumulative HCC incidence among patients who received aspirin was lower compared with nonusers of aspirin (P < .0001). Investigators also saw a correlation between aspirin use and lower risk for HCC (adjusted HR = 0.85; 95% CI, 0.78–0.92). Data showed a lower cumulative incidence of HCC in aspirin users without cirrhosis (16,507 pairs; aHR = 0.87 for HCC; 95% CI, 0.79–0.95).
“However, in patients with cirrhosis, there was no significant difference in the risk of HCC development between the aspirin treated group and the nontreated group,” Jang said.
Moreover, the correlation between aspirin therapy and HCC was not clearly evident (aHR = 1; 95% CI, 0.85–1.18).
Perspective
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Christina Lindenmeyer, MD
HCC is an important complication of chronic hepatitis B infection that may be seen in patients with and without cirrhosis. HCC contributes significantly to the morbidity and mortality observed in this specific patient population.
Aspirin has been widely studied as a chemo-protective agent in liver disease. Observational and population-based studies have suggested lower rates of HCC in patients maintained on aspirin, as well as lower overall rates of liver-rated mortality. The effect appears to be duration-dependent, with apparent benefits observed more frequently with chronic use.
The authors present an interesting analysis of a large cohort of patients with chronic hepatitis B from the Korean National Health insurance database. Out of 329,635 patients, 20,200 patients had received aspirin therapy for 90 or more consecutive days, whereas the remaining patients were aspirin naïve. Patients were matched using a propensity score matching analysis.
Their analysis suggests a lower risk of HCC patients with chronic hepatitis B infection who were treated with aspirin therapy for 90 consecutive days or more. Notably, this risk reduction was only observed in non-cirrhotic patients. In patients with cirrhosis, the authors found no difference in the risk for HCC development between aspirin users and non-users.
Certainly, more information is needed before aspirin can be widely recommended in patients with hepatitis B or other forms of liver disease. This study reinforces the need for randomized clinical trials to determine the role of aspirin in the primary prevention of HCC.
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