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Abstract
Background Patients with type 2 diabetes mellitus (T2DM) have higher pancreatic cancer (PC) risk. While aspirin has chemopreventive effects on digestive cancers, its effect on PC among patients with T2DM is unclear.
Methods This retrospective cohort study identified newly diagnosed adult patients with T2DM in Hong Kong between 2001 and 2015 from a territory-wide healthcare registry. Exclusion criteria were history of PC, pancreatic cyst, IgG4 disease, or pancreatectomy. To address reverse causality between PC and T2DM, we excluded patients with PC diagnosed within 1 year of T2DM. We also excluded patients with less than 1 year of observation. Primary outcome was PC, and secondary outcomes were PC-related and all-cause mortality. Aspirin use was treated as time-varying variable (≥180 day-use/year) to address immortal-time bias, and multivariable Cox regression model was employed to derive adjusted HR (aHR). Propensity-score (PS) matching was used as secondary analysis.
Results Among 343 966 newly diagnosed patients with T2DM (median follow-up: 10.5 years; IQR: 7.7–14.5 years), 1224 (0.36%) developed PC. There were 51 151 (14.9%) deaths from any cause, and 787 (0.2%) died from PC. Aspirin use was associated with lower PC risk in both time-dependent (aHR: 0.58; 95% CI 0.49 to 0.69) and PS matching analysis (aHR: 0.61; 95% CI 0.48 to 0.77). An inverse relationship was observed with increasing dose and duration of aspirin use (P trend<0.001). Aspirin was also associated with a lower risk of PC-related mortality (aHR: 0.43; 95% CI 0.34 to 0.53) and all-cause mortality (aHR: 0.78; 95% CI 0.76 to 0.80).
Conclusion Aspirin use may be an oncopreventive strategy to reduce PC risk in patients with T2DM. Further studies are warranted to validate the study findings.
- ASPIRIN
- PANCREATIC CANCER
- DIABETES MELLITUS
- CHEMOPREVENTION
Data availability statement
Data may be obtained from a third party and are not publicly available. The data of this study were provided by the Hong Kong Hospital Authority. Restrictions apply to the availability of these data, which were used under license.
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Data availability statement
Data may be obtained from a third party and are not publicly available. The data of this study were provided by the Hong Kong Hospital Authority. Restrictions apply to the availability of these data, which were used under license.
Footnotes
X @waikleung_hk
Contributors Study concept and design; data analysis: JT-T, KSC and W-KS. Data acquisition: JT-T, KSC, HMC and XM. Data interpretation: JT-T, KSC, XM and W-KS. Manuscript draft: JT-T, KSC, WKL and W-KS. Data analysis plan and data management: JT-T. Critical revision of manuscript and overall study supervision: KSC, WKL and W-KS. Guarantor of the study: KSC. All authors participated in the preparation of the manuscript and have seen and approved the final version.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests WKS received speaker’s fees from AstraZeneca, is an advisory board member and received speaker’s fees of Abbott, received research funding from Alexion Pharmaceuticals, Boehringer Ingelheim, Pfizer and Ribo Life Science, and is an advisory board member, received speaker’s fees and researching funding from Gilead Sciences. The other authors have nothing to disclose.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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