Association of Low-Dose Aspirin and Survival of Women With... : Obstetrics & Gynecology (original) (raw)

Contents: Original Research

Matsuo, Koji MD, PhD; Cahoon, Sigita S. MD; Yoshihara, Kosuke MD, PhD; Shida, Masako MD, PhD; Kakuda, Mamoru MD; Adachi, Sosuke MD, PhD; Moeini, Aida MD; Machida, Hiroko MD; Garcia-Sayre, Jocelyn MD; Ueda, Yutaka MD, PhD; Enomoto, Takayuki MD, PhD; Mikami, Mikio MD, PhD; Roman, Lynda D. MD; Sood, Anil K. MD

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, and the Norris Comprehensive Cancer Center, Los Angeles, California; the Departments of Obstetrics and Gynecology, Tokai University School of Medicine, Kanagawa, Osaka University Graduate School of Medicine, Osaka, and Niigata University Graduate School of Medicine, Niigata, Japan; and the Departments of Gynecologic Oncology and Cancer Biology and the Center for RNA Interference and Non-Coding RNAs, the University of Texas MD Anderson Cancer Center, Houston, Texas.

Corresponding author: Koji Matsuo, MD, PhD, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, 2020 Zonal Avenue, IRD 520, Los Angeles, CA 90089; e-mail: [email protected].

Supported by Ensign Endowment for Gynecologic Cancer Research (Koji Matsuo) and the Frank McGraw Memorial Chair in Cancer Research (Anil K. Sood).

Financial Disclosure The authors did not report any potential conflicts of interest.

Presented at 47th Annual Meeting on Women's Cancer, March 19–22, 2016, San Diego, California.

OBJECTIVE:

To examine the survival outcomes in women with endometrial cancer who were taking low-dose aspirin (81–100 mg/d).

METHODS:

A multicenter retrospective study was conducted examining patients with stage I–IV endometrial cancer who underwent hysterectomy-based surgical staging between January 2000 and December 2013 (N=1,687). Patient demographics, medical comorbidities, medication types, tumor characteristics, and treatment patterns were correlated to survival outcomes. A Cox proportional hazard regression model was used to estimate adjusted hazard ratio for disease-free and disease-specific overall survival.

RESULTS:

One hundred fifty-eight patients (9.4%, 95% confidence interval [CI] 8.8–11.9) were taking low-dose aspirin. Median follow-up time for the study cohort was 31.5 months. One hundred twenty-seven patients (7.5%) died of endometrial cancer. Low-dose aspirin use was significantly correlated with concurrent obesity, hypertension, diabetes mellitus, and hypercholesterolemia (all P<.001). Low-dose aspirin users were more likely to take other antihypertensive, antiglycemic, and anticholesterol agents (all _P_<.05). Low-dose aspirin use was not associated with histologic subtype, tumor grade, nodal metastasis, or cancer stage (all _P_>.05). On multivariable analysis, low-dose aspirin use remained an independent prognostic factor associated with an improved 5-year disease-free survival rate (90.6% compared with 80.9%, adjusted hazard ratio 0.46, 95% CI 0.25–0.86, _P_=.014) and disease-specific overall survival rate (96.4% compared with 87.3%, adjusted hazard ratio 0.23, 95% CI 0.08–0.64, _P_=.005). The increased survival effect noted with low-dose aspirin use was greatest in patients whose age was younger than 60 years (5-year disease-free survival rates, 93.9% compared with 84.0%, _P_=.013), body mass index was 30 or greater (92.2% compared with 81.4%, _P_=.027), who had type I cancer (96.5% compared with 88.6%, _P_=.029), and who received postoperative whole pelvic radiotherapy (88.2% compared with 61.5%, _P_=.014). These four factors remained significant for disease-specific overall survival (all P<.05).

CONCLUSION:

Our results suggest that low-dose aspirin use is associated with improved survival outcomes in women with endometrial cancer, especially in those who are young, obese, with low-grade disease, and who receive postoperative radiotherapy.