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Aspirin use may prevent cholangiocarcinoma

Aspirin use was associated with a 2.7-fold to 3.6-fold decreased risk for developing intrahepatic, perihilar and distal cholangiocarcinoma, according to findings published in Hepatology.

“Until now, there has been little evidence of a potential role for aspirin in the prevention of bile duct cancer,” Roongruedee Chaiteerakij, MD, PhD, of the department of medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thailand, and of the division of gastroenterology and hepatology, Mayo Clinic College of Medicine, Rochester, Minn., said in a press release. “Our study provides the first evidence for this.”

Chaiteerakij and colleagues — including Lewis R. Roberts, MB, ChB, PhD, and Jonggi Choi, MD, both from the division of gastroenterology and hepatology, Mayo Clinic, Rochester, Minn., — conducted a case-control study comparing all cases of cholangiocarcinoma (CCA; n = 2,395) seen at the Mayo Clinic in Minnesota between 2000 and 2014 with controls (n = 4,769) selected from the Mayo Clinic Biobank. The patients with CCA were matched two to one with controls by age, sex, race and residence. Associations between aspirin use, other risk factors and CCA risk were measured through various analyses.

Lewis R. Roberts

Patients were identified with intrahepatic (n = 1,169), perihilar (n = 995) or distal CCA (n = 231). A total of 591 patients with CCA (24.7%) and 2,129 controls (44.6%) used aspirin.

Researchers observed an inverse association between aspirin use and all CCA subtypes: adjusted OR of 0.35 for intrahepatic CCA (95% CI, 0.29-0.42), adjusted OR of 0.34 for perihilar CCA (95% CI, 0.27-0.42) and adjusted OR of 0.29 for distal CCA (95% CI, 0.19-0.44; P < .001 for all).

Sensitivity analysis showed aspirin use was significantly associated with decreased CCA risk, with an adjusted OR of 0.41 for the Rochester Epidemiology Project subset of patients (95% CI, 0.28-0.61) and adjusted OR of 0.23 for the Minnesota subset (95% CI, 0.18-0.30; P < .001 for both).

In addition, patients with CCA were less likely to report aspirin use compared with controls (OR = 0.41; 95% CI, 0.36-0.45).

Multivariate analysis showed primary sclerosing cholangitis (PSC) was the most significant risk factor for CCA (adjusted OR = 171; 95% CI, 72.6-404). PSC was more strongly associated with perihilar (adjusted OR = 453; 95% CI, 104-999) vs. intrahepatic (adjusted OR = 93.4; 95% CI, 27.1-322) or distal CCA (adjusted OR = 34; 95% CI, 3.6-323). Diabetes was more associated with distal (adjusted OR = 4.2; 95% CI, 2.5-7) compared with perihilar (adjusted OR = 2.9; 95% CI, 2.2-3.8) or intrahepatic CCA (adjusted OR = 2.5; 95% CI, 2.0-3.2). Isolated inflammatory bowel disease without PSC was not associated with any CCA subtype.

“PSC, biliary tract diseases, non-PSC-related cirrhosis, [hepatitis B virus infection], diabetes and smoking conferred risk of different magnitudes for the different CCA subtypes,” the researchers wrote. “This supports the hypothesis that the three CCA subtypes are distinct diseases and that each subtype thus has its own susceptibility to risk factors.”

“The next steps should include population-based studies examining the associations of aspirin use with risk of bile duct cancer and also clinical trials, particularly in populations at high-risk for bile duct cancer, to confirm the benefit of aspirin for bile duct cancer prevention,” Roberts said in the release. – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.