ASSOCIATION BETWEEN DAILY ASPIRIN THERAPY AND HEPATOCELLULAR CARCINOMA ACCORDING TO METABOLIC RISK FACTOR BURDEN IN PATIENTS WITH CHRONIC HEPATITIS B

Abstract

Background: Several studies have provided evidence supporting chemopreventive effect of aspirin against hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) patients. Recently, we demonstrated that daily aspirin use was associated with reduced HCC risk in non-cirrhotics with CHB, but not in cirrhotics. To identify better candidates for daily aspirin therapy, we investigated the association of aspirin use with HCC risk according to metabolic risk factor burden, which is an independent risk factor of HCC, among non-cirrhotics with CHB. Methods: We collected baseline data on metabolic risk factors, including obesity, high blood pressure, hypercholesterolemia, and diabetes, in 282,611 adult non-cirrhotics with CHB using the Korean National Health Insurance Service database. The study patients were stratified according to the number of metabolic risk factors, after which propensity score-matched cohorts were generated to balance baseline characteristics between aspirin users and nonusers. The risk of HCC was analyzed, accounting for competing risks. Results: In overall population, 11,024 patients developed HCC during a median follow-up period of 7.4 years. The cumulative incidences of HCC rose with increasing metabolic risk factor burden (P<.0001; panel A). Among patients with ≤2 metabolic risk factors (13,104 pairs), the cumulative incidences of HCC in aspirin users were significantly lower than in nonusers (P=.005; panel B); however, aspirin use was not associated with lower HCC risk after multivariable adjustment (adjusted hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.84–1.03; P=.18). Among patients with ≥3 metabolic risk factors (2,984 pairs), aspirin users showed significantly lower cumulative HCC incidences compared to nonusers (P=.005; panel C) and aspirin use was associated with 28% reduced risk of HCC (adjusted HR, 0.72; 95% CI, 0.57–0.91; P=.006). Conclusion: In this Korean nationwide cohort study, daily aspirin use was associated with reduced risk of HCC in non-cirrhotic CHB patients with higher burden of metabolic risk factors.