Beneficial Prognostic Effects of Aspirin in Patients Receiving Sorafenib for Hepatocellular Carcinoma: A Tale of Multiple Confounders
Case–control observational studies suggested that aspirin might prevent hepatocellular carcinoma (HCC) in high-risk patients, even if randomized clinical trials are lacking. Information regarding aspirin in subjects who already developed HCC, especially in its advanced stage, are scarce. While aspir...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-12-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/13/24/6376 |
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| author | Luca Ielasi Francesco Tovoli Matteo Tonnini Raffaella Tortora Giulia Magini Rodolfo Sacco Tiziana Pressiani Franco Trevisani Vito Sansone Giovanni Marasco Fabio Piscaglia Alessandro Granito |
| author_facet | Luca Ielasi Francesco Tovoli Matteo Tonnini Raffaella Tortora Giulia Magini Rodolfo Sacco Tiziana Pressiani Franco Trevisani Vito Sansone Giovanni Marasco Fabio Piscaglia Alessandro Granito |
| author_sort | Luca Ielasi |
| collection | DOAJ |
| description | Case–control observational studies suggested that aspirin might prevent hepatocellular carcinoma (HCC) in high-risk patients, even if randomized clinical trials are lacking. Information regarding aspirin in subjects who already developed HCC, especially in its advanced stage, are scarce. While aspirin might be a low-cost option to improve the prognosis, multiple confounders and safety concerns are to be considered. In our retrospective analyses of a prospective dataset (<i>n</i> = 699), after assessing the factors associated with aspirin prescription, we applied an inverse probability treatment weight analysis to address the prescription bias. Analyses of post-sorafenib survival were also performed to reduce the influence of subsequent medications. Among the study population, 133 (19%) patients were receiving aspirin at the time of sorafenib prescription. Aspirin users had a higher platelet count and a lower prevalence of esophageal varices, macrovascular invasion, and Child–Pugh B status. The benefit of aspirin was confirmed in terms of overall survival (HR 0.702, 95% CI 0.543–0.908), progression-free survival, disease control rate (58.6 vs. 49.5%, <i>p</i> < 0.001), and post-sorafenib survival even after weighting. Minor bleeding events were more frequent in the aspirin group. Aspirin use was associated with better outcomes, even after the correction for confounders. While safety concerns arguably remain a problem, prospective trials for patients at low risk of bleeding are warranted. |
| first_indexed | 2024-03-10T04:32:19Z |
| format | Article |
| id | doaj.art-f5da7443cbf44acba8b4c682412a6024 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T04:32:19Z |
| publishDate | 2021-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-f5da7443cbf44acba8b4c682412a60242023-11-23T04:07:56ZengMDPI AGCancers2072-66942021-12-011324637610.3390/cancers13246376Beneficial Prognostic Effects of Aspirin in Patients Receiving Sorafenib for Hepatocellular Carcinoma: A Tale of Multiple ConfoundersLuca Ielasi0Francesco Tovoli1Matteo Tonnini2Raffaella Tortora3Giulia Magini4Rodolfo Sacco5Tiziana Pressiani6Franco Trevisani7Vito Sansone8Giovanni Marasco9Fabio Piscaglia10Alessandro Granito11Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, ItalyDivision of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, ItalyDivision of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, ItalyLiver Unit, Department of Transplantation, Cardarelli Hospital, 80131 Naples, ItalyDepartment of Gastroenterology and Transplant Hepatology, Papa Giovanni XXIII Hospital, 24127 Bergamo, ItalyGastroenterology Unit, Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, ItalyHumanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, ItalyDepartment of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, ItalyDivision of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, ItalyDepartment of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, ItalyDivision of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, ItalyDivision of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, ItalyCase–control observational studies suggested that aspirin might prevent hepatocellular carcinoma (HCC) in high-risk patients, even if randomized clinical trials are lacking. Information regarding aspirin in subjects who already developed HCC, especially in its advanced stage, are scarce. While aspirin might be a low-cost option to improve the prognosis, multiple confounders and safety concerns are to be considered. In our retrospective analyses of a prospective dataset (<i>n</i> = 699), after assessing the factors associated with aspirin prescription, we applied an inverse probability treatment weight analysis to address the prescription bias. Analyses of post-sorafenib survival were also performed to reduce the influence of subsequent medications. Among the study population, 133 (19%) patients were receiving aspirin at the time of sorafenib prescription. Aspirin users had a higher platelet count and a lower prevalence of esophageal varices, macrovascular invasion, and Child–Pugh B status. The benefit of aspirin was confirmed in terms of overall survival (HR 0.702, 95% CI 0.543–0.908), progression-free survival, disease control rate (58.6 vs. 49.5%, <i>p</i> < 0.001), and post-sorafenib survival even after weighting. Minor bleeding events were more frequent in the aspirin group. Aspirin use was associated with better outcomes, even after the correction for confounders. While safety concerns arguably remain a problem, prospective trials for patients at low risk of bleeding are warranted.https://www.mdpi.com/2072-6694/13/24/6376hepatocellular carcinomaliver cirrhosisliver canceraspirinoutcomesorafenib |
| spellingShingle | Luca Ielasi Francesco Tovoli Matteo Tonnini Raffaella Tortora Giulia Magini Rodolfo Sacco Tiziana Pressiani Franco Trevisani Vito Sansone Giovanni Marasco Fabio Piscaglia Alessandro Granito Beneficial Prognostic Effects of Aspirin in Patients Receiving Sorafenib for Hepatocellular Carcinoma: A Tale of Multiple Confounders Cancers hepatocellular carcinoma liver cirrhosis liver cancer aspirin outcome sorafenib |
| title | Beneficial Prognostic Effects of Aspirin in Patients Receiving Sorafenib for Hepatocellular Carcinoma: A Tale of Multiple Confounders |
| title_full | Beneficial Prognostic Effects of Aspirin in Patients Receiving Sorafenib for Hepatocellular Carcinoma: A Tale of Multiple Confounders |
| title_fullStr | Beneficial Prognostic Effects of Aspirin in Patients Receiving Sorafenib for Hepatocellular Carcinoma: A Tale of Multiple Confounders |
| title_full_unstemmed | Beneficial Prognostic Effects of Aspirin in Patients Receiving Sorafenib for Hepatocellular Carcinoma: A Tale of Multiple Confounders |
| title_short | Beneficial Prognostic Effects of Aspirin in Patients Receiving Sorafenib for Hepatocellular Carcinoma: A Tale of Multiple Confounders |
| title_sort | beneficial prognostic effects of aspirin in patients receiving sorafenib for hepatocellular carcinoma a tale of multiple confounders |
| topic | hepatocellular carcinoma liver cirrhosis liver cancer aspirin outcome sorafenib |
| url | https://www.mdpi.com/2072-6694/13/24/6376 |
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