Daily aspirin therapy linked to lower liver cancer risk

People with hepatitis B virus (HBV) who took an aspirin a day – often recommended to help prevent cardiovascular disease – had a lower risk of developing liver cancer, according to a study from Taiwan presented at the 2017 AASLD Liver Meeting this week in Washington, DC.

"For effectively preventing HBV‐related liver cancer, the findings of this study may help hepatologists treat patients with chronic HBV infection in the future, particularly for those who are not indicated for antiviral therapy," said lead researcher Teng-Yu Lee of Taichung Veterans General Hospital.

Over years or decades, chronic hepatitis B or C, heavy alcohol use, fatty liver disease and other causes of liver injury can lead to the development of cirrhosis and hepatocellular carcinoma (HCC), a type of primary liver cancer.

HBV antiviral therapy using nucleoside/nucleotide analogues such as tenofovir (Viread or Vemlidy) or entecavir (Baraclude) has been shown to reduce – although not completely eliminate – the risk of liver cancer, but many people with chronic hepatitis B are not considered eligible for this treatment.

Lee's team sought to determine whether there is an association between aspirin therapy and HBV-related liver cancer risk.

Often prescribed as a pain reliever, aspirin also has anti-inflammatory properties and inhibits blood clotting. Taking a low-dose aspirin each day is recommended for the prevention of cardiovascular disease and colon cancer in older adults, but there is little research about its effect on liver cancer.

This study looked at a nationwide cohort using medical records from the Taiwan National Health Insurance Research Database between 1998 and 2012. The researchers screened 204,507 people with chronic hepatitis B, excluding those with other types of viral hepatitis.

The analysis included 1553 people who had used continuous daily aspirin therapy for at least three months, averaging nearly four years. They were matched by age and sex with four people who did not regularly take aspirin (totalling 6212 control subjects).

About three quarters were men and the average age was 54 years. About 5% had liver cirrhosis and under 10% were treated with nucleoside/nucleotide analogues. Pre-existing cardiovascular disease and risk factors such as diabetes and high blood pressure were more common in the aspirin group

The incidence of liver cancer among people taking daily aspirin was significantly lower than the rate in the non-aspirin group. While about 3% of people in the aspirin group developed HCC over five years, this rose to about 6% in the non-aspirin group.

Aspirin therapy was associated with a 37% reduction in the risk of HCC in a multivariate analysis controlling for other factors (hazard ratio [HR] 0.63). Other independent risk factors for liver cancer included male sex (HR 2.65), older age (HR 1.03 per year), cirrhosis (HR 1.89) and diabetes (HR 1.51), while use of statins and nucleoside/nucleotide analogues were associated with a lower risk (HR 0.57 for each).

Based on these results, the researchers concluded, "Aspirin therapy was significantly associated with a reduced risk of HCC in patients with chronic hepatitis B."