Prevention by Aspirin of Colorectal Adenoma Recurrence: Some Advances and Latest Results of the APACC Trial
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : Robert Benamouzig & Bernard Uzzan & Jacques Deyra & Antoine Martin & Stanislas Chaussade
- چاپ و سال / کشور: 2010
Description
In a randomized controlled trial (RCT), 272 patients were assigned to lysine acetylsalicylate 160 mg/day (n=73) or 300 mg/day (n=67) or placebo (n=132). The primary end points were adenoma recurrence and adenomatous polyp burden (APB) at year 1 or 4 (last colonoscopy) and at year 4. At last colonoscopy, APB tended to be lower under aspirin 160 mg or at either dose compared with placebo (P=0.06 and 0.07, respectively). At year 4, 55 patients had received aspirin 160 mg/d, 47,300 mg/d, and 83 placebo. APB and proportions of patients with at least one recurrent adenoma were similar in both groups. A personal history of adenomas and an initial APB higher than 10 mm predicted recurrence. Among 219 adenomas from 136 patients, 128 adenomas (58%) from 59 patients strongly expressed COX-2 assessed by immunohistochemistry, mainly adenomas larger than 10 mm (84/129 vs 44/90; P= 0.02) and adenomas showing high-grade dysplasia (22/29 vs 104/188; P=0.04). Deep stromal initial expression of COX-2 predicted recurrence (P=0.04). Protection by aspirin was mainly observed in patients in whom COX-2 initial expression was low (RR: 0.59; 95% CI=0.39–0.90; P= 0.02). Aspirin decreased adenoma recurrence significantly at 1 year, marginally at year 1 or 4, and not at year 4, possibly due to attrition but also to a differential effect according to polyp natural history. In a recent patient-level meta-analysis including the four published RCTs, aspirin significantly decreased adenoma risk by 17% and risk of advanced lesions by 28%.
Curr Colorectal Cancer Rep (2011) 7:33–41 DOI 10.1007/s11888-010-0079-5 Published online: 24 December 2010
