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Aspirin in Patients with Viral Hepatitis: Systematic Review and Meta-Analysis of Observational Studies

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Abstract

Background

Hepatocellular carcinoma (HCC) is a disease demonstrating increasing morbidity and mortality, especially in patients with chronic viral hepatitis. Studies have shown that aspirin can reduce the incidence of liver cancer; however, the degree of benefit in patients with viral hepatitis is unclear. This study focused on the association between aspirin use and HCC risk in patients with chronic viral hepatitis.

Methods

A systematic search of the PubMed, Embase, Web of Science, and Cochrane Library databases was performed from the earliest available date to December 16, 2023. The primary outcome was HCC incidence, and the secondary outcome was gastrointestinal bleeding. The results were expressed as hazard ratios (HRs) and 95% confidence intervals (CIs). Meta-analyses were performed by using random or fixed-effects models based on the heterogeneity assessed via the I2 statistic.

Results

A total of 13 articles (303,414 participants and 14,423 HCC patients) were included in the analysis. The incidence of HCC in aspirin users was lower than that in non-aspirin users (HR 0.75; 95% CI, 0.68–0.83; P < 0.001; I2 = 90.0%). Subgroup analysis further showed that this effect may be more obvious in HCV patients, non-cirrhotic patients, patients with statins, and long-term aspirin users, but it may have the risk of gastrointestinal bleeding (HR 1.13; 95% CI, 1.07–1.20; P = 0.906; I2 = 0.0%).

Conclusions

Our meta-analysis shows that in patients with chronic viral hepatitis, aspirin use is associated with a significantly reduced risk of liver cancer, but attention should be paid to the possible risk of gastrointestinal bleeding, and this conclusion needs further validation in the future.

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Data Availability

The datasets related to the research results of this article are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Chengdu University of Traditional Chinese Medicine, Chengdu, China

    Wentao Bian, Qingyu Li & Yulian Li

  2. National Radio Spectrum Management Research Institute, **’an, China

    Wenkai Bian

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Contributions

Wentao Bian and Wenkai Bian contributed to the conception and design of the work. Wentao Bian, Qingyu Li, and Yulian Li collected information and analyzed data used in the systematic review and meta-analysis. Wenkai Bian provided software and participated in the production of pictures. Wentao Bian and Wenkai Bian substantively revised it.

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Correspondence to Wentao Bian.

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Bian, W., Bian, W., Li, Q. et al. Aspirin in Patients with Viral Hepatitis: Systematic Review and Meta-Analysis of Observational Studies. J Gastrointest Canc 55, 638–651 (2024). https://doi.org/10.1007/s12029-024-01027-5

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