Low-dose aspirin linked to reduced liver cancer risk

Among adults at high risk of liver cancer, those who took low-dose aspirin were less likely to develop the disease or to die from liver-related causes. The findings come from an analysis published in the New England Journal of Medicine and conducted by a team led by investigators at the Karolinska Institutet, in Sweden, and Massachusetts General Hospital (MGH).

"Rates of liver cancer and of mortality from liver disease are rising at an alarming pace in U.S. and European countries. Despite this, there remain no established treatments to prevent the development of liver cancer, or to reduce the risk of liver-related death," said lead author Tracey Simon, MD, MPH, investigator in the Division of Gastroenterology and Hepatology at MGH.

For the analysis, investigators examined information from Swedish registries on 50,275 adults who had chronic viral hepatitis, a type of liver infection that is caused by the hepatitis B or C virus and is the most common risk factor for liver cancer. Over a median follow-up of nearly 8 years, 4.0% of patients who took low-dose aspirin (less than 163mg/day) and 8.3% of nonusers of aspirin developed liver cancer. Aspirin users had a 31% lower relative risk of developing liver cancer.

Importantly, the study showed that the longer a person took low-dose aspirin, the greater the benefit. Compared with short-term use (3 months to 1 year), the risk of liver cancer was 10% lower for 1-3 years of use, 34% lower for 3-5 years of use, and 43% lower for 5 or more years of use.

Also, liver-related deaths occurred in 11.0% of aspirin users compared with 17.9% of nonusers over 10 years, for a 27% lower risk.

The benefits were seen regardless of sex, severity of hepatitis, or type of hepatitis virus (B or C). The risk of internal bleeding--a concern when taking aspirin long-term--was not significantly elevated among aspirin users.

"This is the first large-scale, nationwide study to demonstrate that the use of aspirin is associated with a significantly reduced long-term risk of liver cancer and liver-related mortality," said senior author Jonas F. Ludvigsson, MD, PhD, of the Department of Medical Epidemiology and Biostatistics at the Karolinska Institutet.?

The investigators noted that prospective randomized controlled trials are needed to test the benefits of aspirin for patients affected by liver disease.

Tracey G Simon, Ann-Sofi Duberg, Soo Aleman, Raymond T Chung, Andrew T Chan, Jonas F Ludvigsson.
Association of Aspirin with Hepatocellular Carcinoma and Liver-Related Mortality.
N Engl J Med 2020; 382:1018-1028. doi: 10.1056/NEJMoa1912035

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