Low-dose aspirin yields no survival benefit in gastric adenocarcinoma

Use of low-dose aspirin appears to have a null effect on the 5-year survival of patients who undergo gastrectomy for gastric adenocarcinoma, a study reports.

The study included 2,025 patients who underwent gastrectomy for gastric adenocarcinoma in Sweden. Researchers assessed preoperative exposure to a daily low-dose (75–160 mg) aspirin over 1, 2, and 3 years, as well as at 1 year after the procedure, in relation to 5-year all-cause mortality and disease-specific mortality.

Overall, the patients contributed a total of 5,684 person-years and a mean of 2.8 person-years of follow-up. There were 545 (26.9 percent) patients who used aspirin at the time of surgery, among whom 178 (32.7 percent) discontinued use after the surgery. Fifty-six (2.8 percent) patients started using aspirin within a year of gastrectomy.

Compared with nonusers, aspirin users were more likely to be older, men, have lower education, more comorbidities, more statin use, more severe complications (Clavien Dindo ≥ 3), lower rate of neoadjuvant chemotherapy, and a higher rate of sub-total compared to total gastrectomy.

Within 90 days of surgery, 52 (9.5 percent) aspirin users and 91 (6.2 percent) nonusers died. Multivariable Cox regression analysis revealed that aspirin use within 1 year before surgery did not reduce the adjusted risk of 5-year all-cause mortality (hazard ratio [HR], 0.98, 95 percent confidence interval [CI], 0.85–1.13) or disease-specific mortality (HR, 1.00, 95 percent CI, 0.86–1.17).

Likewise, there were no survival benefits noted with preoperative aspirin use for 2 (HR, 0.98, 95 percent CI, 0.84–1.15) or 3 years (HR, 0.94, 95 percent CI, 0.79–1.12). Moreover, patients who persisted with aspirin during the first year after gastrectomy had a similar 5-year all-cause mortality as nonusers (HR, 1.01, 95 percent CI, 0.82–1.25).