Aspirin but not statins is inversely related to gastric cancer with a duration-risk effect: Results from the Stomach Cancer Pooling Project Consortium

Abstract

Background: Aspirin and statins have been suggested to have potential chemopreventive effects against gastric cancer (GC), although the results of previous studies have been inconsistent. This study therefore aimed to investigate the association between the use of aspirin and statins and GC.

Methods: A pooled analysis of seven case-control studies within the Stomach Cancer Pooling Project, including 3220 cases and 9752 controls, was conducted. Two-stage modeling analyses were used to estimate the association between aspirin and statin use and GC after adjusting for potential confounders.

Results: The pooled odds ratio (OR) of GC for aspirin users versus nonusers was 0.72 (95% confidence interval [CI], 0.54-0.95). The protective effect of aspirin appeared stronger in individuals without a GC family history (OR, 0.60; 95% CI, 0.37-0.95), albeit with borderline heterogeneity between those with and without a family history (p = .064). The OR of GC decreased with increasing duration of aspirin use, with an OR of 0.41 (95% CI, 0.18-0.95) for durations of ≥15 years. An inverse, nonsignificant association with the risk of GC was observed for the use of statins alone (OR, 0.79; 95% CI, 0.52-1.18).

Conclusions: These findings suggest that aspirin use, particularly long-term use, is associated with a reduced risk of GC, whereas a similar association was not observed with statins, possibly because of the low frequency of use.

Keywords: aspirin; epidemiological study; gastric cancer; statins.

FIGURE 1

Study‐specific and adjusted pooled ORs and corresponding 95% CIs of gastric cancer risk for aspirin and statin users compared with nonusers. ORs were adjusted for age at diagnosis/interview (continuous), sex, socioeconomic status, smoking status, alcohol intake, and body mass index category. CI indicates confidence interval; OR, odds ratio.

FIGURE 2

Results of the dose–response analysis of the duration of aspirin intake and gastric cancer fitted by using a one‐stage logistic mixed‐effects model with fractional polynomials (adjusted for age at diagnosis/interview [continuous], sex, socioeconomic status, smoking status, alcohol intake, and body mass index category). The analysis was based on 4194 subjects (637 cases; 3557 controls) from studies Italy 1 and Spain. Bold line represents the odds ratio (OR); dashed lines: upper and lower limits of the 95% confidence interval (CI).