阿司匹林在乳腺癌防治中应用研究进展

目的 总结国内外对阿司匹林与乳腺癌防治研究的最新进展,并就阿司匹林抗乳腺癌的机制、安全性及风险获益分析进行综述.方法 应用PubMed、Web of Science及CNKI期刊全文数据库检索系统,以“阿司匹林(aspirin)、非甾体类抗炎药(non-steroidal anti-inflammatory drugs,NSAIDs)、癌(cancer,tumor,neoplasm,carcinoma)、乳腺癌(breastcancer)”等为关键词,检索2000-2016的相关文献,共检索到英文文献1 759条,中文文献231条.纳入标准:(1)阿司匹林或非甾体类抗炎药与癌症防治或乳腺癌防治相关的基础研究、临床研究、荟萃分析等;(2)长期服用阿司匹林的安全性、风险获益分析;(3)发表年限较近的文章.剔除标准:(1)文献中所研究的非甾体类抗炎药不包含阿司匹林;(2)发表年限较久远的文章;(3)重复性文献.根据纳入及排除标准,最后纳入分析40篇文献.结果 阿司匹林主要通过抑制体内环氧化酶活性发挥抗乳腺癌作用,长期服用阿司匹林增加了溃疡、出血等风险,但对于低出血风险及高乳腺癌风险的患者来说获益大于风险.大量研究证明,阿司匹林具有抗乳腺癌作用,但目前各研究结果结论不一,其是否可以降低乳腺癌的发病率和死亡率以及抑制乳腺癌的复发和转移尚存在争议.结论 阿司匹林是癌症防治的新策略,有望成为乳腺癌的有效防治措施,但仍需要更多大型多中心临床研究进行进一步研究和论证.

Role of aspirin in prevention and treatment of breast cancer

OBJECTIVE To summarize the recent progress of aspirin in prevention and treatment of breast cancer and review its mechanism,safety and risk-benefit.METHODS Articles were retrieved in PubMed,Web of Science and CNKI fulltext database from 2000 to 2016 using "aspirin,acetylsalicylic acid,non-steroidal anti-inflammatory drugs,NSAIDs,cancer,tumor,neoplasm,carcinoma,breast cancer" as keywords.A total of 1 759 English articles and 231 Chinese articles were retrieved according to the inclusion criteria as follows:the prevention and treatment of cancer or breast cancer,basic research,clinical research,or meta analysis on the relation of aspirin or NSAIDs;the safety and riskbenefit analysis of long-term use of aspirin;publication year closer in.Exclusion criteria:the NSAIDs studied in the literature does not include aspirin;old-year or repeatable articles.Totally 40 articles were finally selected and analyzed according to the criteria.RESULTS Cyclooxygenases inhibition and the suppression of prostaglandin synthesis are the main mechanism of anti-cancer activity of aspirin.Long-term aspirin use increases the risks of ulcer and bleeding.However,patients with low-risk of hemorrhage and high-risk of breast cancer may have favorable benefit harm profile.Lots of studies indicate a beneficial role of aspirin for breast cancer.Nevertheless,its effect to reduce the morbidity and mortality and to inhibit the recurrence and metastasis of breast cancer remains controversial because the results of trials vary from each other.CONCLUSIONS As a new strategy for cancer prevention and treatment,prophylactic aspirin use plays an important role and is expected to be a new and effective regimen for the prevention and treatment of breast cancer.However,further researches are still needed.