Aspirin reduces risk of liver cancer in hepatitis B patients

Daily aspirin was associated with a significantly reduced risk in hepatitis B virus‐related liver cancer, finds a new study. The study was presented at The Liver Meeting® – held by the American Association for the Study of Liver Diseases.

Past research suggests that daily aspirin therapy may prevent the development of cancer. However, clinical evidence is lacking for the effectiveness of aspirin therapy in preventing HBV‐related liver cancer.

Researchers at Taichung Veterans General Hospital in Taichung, Taiwan and associates conducted a nationwide cohort study to determine if aspirin therapy could, indeed, reduce liver cancer risk.

They explored medical records from the National Health Insurance Research Database between 1998 and 2012 for their study. The records of 204,507 patients with chronic hepatitis B were screened and patients with other forms of infectious hepatitis were excluded. After excluding patients with liver cancer before the follow‐up index dates, 1,553 patients who had continuously received daily aspirin for at least 90 days were randomly matched 1:4 with 6,212 patients who had never received antiplatelet therapy by means of propensity scores consisting of baseline characteristics, the index date and nucleos(t)ide analogue (NA) use during follow‐up. The researchers analyzed both cumulative incidences of and hazard ratios for HCC development after adjusting for competing for mortality.

Hepatitis B is a viral infection that attacks the liver which can be contracted through contact with an infected person’s blood or other bodily fluid, and the infection can either be acute or chronic. Death from HBV is commonly due to the development of cirrhosis or hepatocellular carcinoma.

“Liver cancer is the second leading cause of cancer death worldwide, and HBV is the most prevalent risk factor in our region, says Teng‐Yu Lee, MD, Ph.D., a researcher in the Department of Gastroenterology at Taichung Veterans General Hospital and lead investigator in the study. “HBV‐related liver cancer is, therefore, a major public health issue with a severe socioeconomic impact.”

Although current antiviral medicines such as nucleos(t)ide analogue therapy could significantly reduce liver cancer risk, Dr. Lee notes these therapies do not completely eliminate the risk. Additionally, Dr. Lee says most HBV carriers are not indicated for antiviral therapy, so another effective way of reducing liver cancer risk needs to be developed.

“Aspirin has been investigated to explore its chemopreventive effect in cancers that are related to chronic inflammation, particularly in the prevention of colorectal cancer. However, clinical evidence supporting the chemopreventive effect of aspirin therapy on liver cancer remains limited. Therefore, we conducted a large‐scale cohort study to evaluate the association of aspirin therapy with HBV‐related liver cancer.”

Cumulative incidence of liver cancer in the group treated with aspirin therapy was significantly lower than that in the untreated group in five years. In their multivariate regression analysis, the researchers found aspirin therapy was independently associated with reduced liver cancer risk. Sensitivity subgroup analyses also verified this association. Older age, male gender, cirrhosis, and diabetes also were independently associated with an increased risk, but nucleos(t)ide analogue or statin use was associated with a decreased risk.

“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. We are pursuing prospective investigations for further confirming the findings,” says Dr. Lee.