Low-Dose Aspirin Use Significantly Improves the Survival of Late-stage NPC: A Propensity Score-Matched Cohort Study in Taiwan

Abstract

Background: Aspirin use has been associated with improved survival rates in various cancers. However, it remains unclear if aspirin confers a survival benefit on patients with nasopharyngeal carcinoma (NPC). The aim of this study was to assess the associations between aspirin use and survival in different stages of NPC. Methods: This is a 10-year retrospective cohort study of NPC patients. A total of 565 NPC patients were recruited after we performed a 1:4 propensity score match between aspirin users and non-users. Cox regression models with adjusted covariates were employed to evaluate factors that influence the survival rate of NPC patients. Results: The Kaplan-Meier analysis revealed that the overall survival (p < 0.0001) and disease-specific survival (p < 0.0001) rates of 180-day aspirin users increased. Increased survival rates were also observed in 180-day aspirin users with Stages III and IV, T, N1 and 2, and N3 categories. Cox regression models indicated that factors, including aspirin use (univariate: HR = 0.28, 95% CI = 0.14-0.55, p < 0.001; multivariate: HR = 0.23, 95% CI = 0.12-0.46, p < 0.001), were independent prognostic factors for survival. Conclusions: Aspirin use for more than 180 days is associated with an increased survival rate and is a positive independent prognostic factor in NPC.

Keywords: 10-year follow-up time; disease-specific survival rate; low-dose aspirin; nasopharyngeal carcinoma; overall survival rate.

Figure 1

Flowchart of NPC patient inclusion and exclusion in the study cohort from the Chang Gung Memorial Hospital database. A total of 2666 patients diagnosed with NPC were recruited for this study. Aspirin users (≥180 days) were matched with non-users (None) based on a 1:4 propensity score (PSM), resulting in a final inclusion of 565 patients with NPC for data analysis.

Figure 2

Kaplan–Meier survival curve of OS rates between aspirin users (≥180 days) and non-users. The median OS rates of aspirin non-users (None) was about 5.9 years, and the estimated 5- and 10-year OS rates were 54.9% and 42.4%, respectively. Although median survival was not reached for aspirin users (≥180 days), estimated 5- and 10-year OS rates were 79.9% and 62.0%, respectively. **** indicates p ≤ 0.0001.

Figure 3

Kaplan–Meier survival curve of DSS rates between aspirin users (≥ 180 days) and non-users. The estimated 5- and 10-year DSS rates of aspirin non-users (None) were 66.9% and 55.9%, respectively. The estimated 5- and 10-year DSS rates of aspirin users (≥180 days) were 90.1% and 73.5%, respectively. **** indicates p ≤ 0.0001.