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ASSOCIATION BETWEEN DAILY ASPIRIN THERAPY AND
HEPATOCELLULAR CARCINOMA ACCORDING TO METABOLIC
RISK FACTOR BURDEN IN PATIENTS WITH CHRONIC HEPATITIS B
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AASLD 2021 Nov 12-15
Cheol-Hyung Lee1,2, Yun Bin Lee1, Hyemi Moon3, Jong-Won Chung4, Eun Ju Cho1, Jeong-Hoon Lee1, Su Jong Yu1, Yoon Jun Kim1, Juneyoung Lee3 and Jung-Hwan Yoon1, (1) Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea, (2)The Armed Forces Medical Command, Seongnam, Republic of Korea, (3)Department of Biostatistics, College of Medicine, Korea University, (4)Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Background: Several studies have provided evidence supporting chemopreventive effect of aspirin against hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) patients. Recently, we demonstrated that daily aspirin use was associated with reduced HCC risk in non-cirrhotics with CHB, but not in cirrhotics. To identify better candidates for daily aspirin therapy, we investigated the association of aspirin use with HCC risk according to metabolic risk factor burden, which is an independent risk factor of HCC, among non-cirrhotics with CHB.
Methods: We collected baseline data on metabolic risk factors, including obesity, high blood pressure, hypercholesterolemia, and diabetes, in 282,611 adult non-cirrhotics with CHB using the Korean National Health Insurance Service database. The study patients were stratified according to the number of metabolic risk factors, after which propensity score-matched cohorts were generated to balance baseline characteristics between aspirin users and nonusers. The risk of HCC was analyzed, accounting for competing risks.
Results: In overall population, 11,024 patients developed HCC during a median follow-up period of 7.4 years. The cumulative incidences of HCC rose with increasing metabolic risk factor burden (P<.0001; panel A). Among patients with ≤2 metabolic risk factors (13,104 pairs), the cumulative incidences of HCC in aspirin users were significantly lower than in nonusers (P=.005; panel B); however, aspirin use was not associated with lower HCC risk after multivariable adjustment (adjusted hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.84-1.03; P=.18). Among patients with ≥3 metabolic risk factors (2,984 pairs), aspirin users showed significantly lower cumulative HCC incidences compared to nonusers (P=.005; panel C) and aspirin use was associated with 28% reduced risk of HCC (adjusted HR, 0.72; 95% CI, 0.57-0.91; P=.006).
Conclusion: In this Korean nationwide cohort study, daily aspirin use was associated with reduced risk of HCC in non-cirrhotic CHB patients with higher burden of metabolic risk factors.
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