Cancer Incidence and Mortality With Aspirin in Older Adults: Follow-Up of the ASPREE Trial.

In contrast, the Aspirin in Reducing Events in the Elderly (ASPREE) randomized clinical trial (RCT) reported that low-dose aspirin (LDA) treatment for a median of 4.7 years had no effect on overall cancer incidencebut increased risk of incident late-stage cancer and cancer-related mortality.

相比之下，阿司匹林减少老年人事件（ASPREE）随机临床试验（RCT）报告称，低剂量阿司匹林（LDA）治疗的中位时间为4.7年，对总体癌症发病率没有影响，但增加了晚期癌症和与癌症相关的死亡风险。

Background

To assess whether LDA is associated with cancer incidenceand mortality in 10 years of follow-up in older adults (aged ≥70 years) and to assess the association with cancer after prior LDA exposure (legacy effects).

评估长期低剂量阿司匹林（LDA）是否与70岁及以上老年人（≥70岁）在10年随访期间的癌症发病率和死亡率相关，并评估LDA先前暴露（遗留效应）后与癌症的关联。

DESIGN, SETTING, AND PARTICIPANTS: This community-based binational (Australian and US) cohort study included community-dwelling older adults (aged ≥70 years for Australian participants and ≥65 years for US minority group participants) free from overt cardiovascular disease, dementia, or independence-limiting physical disability.

设计、设置和参与者：这项基于社区的跨国（澳大利亚和美国）队列研究包括社区居住的老年人（澳大利亚参与者年龄≥70岁，美国少数族裔参与者年龄≥65岁），他们没有明显的心血管疾病、痴呆或限制独立生活能力的身体残疾。

The cohort was derived from the ASPREE randomized clinical trial conducted from 2010 to 2017, with the observational extension study (ASPREE-XT) following up participants from 2018 to 2024.

该队列来自2010年至2017年进行的ASPREE随机临床试验，随后的观察性扩展研究（ASPREE-XT）从2018年到2024年对参与者进行随访。

This study reports data from 2010 through 2022 (long-term outcomes) as well as reports analyses confined to the observation phase only (legacy analyses).

本研究报告了2010年至2022年的数据（长期结果），同时也报告了仅限于观察阶段的分析（遗留分析）。

Data were analyzed from May to November 2025.

数据分析从2025年5月至11月进行。

intervention

Daily 100-mg aspirin or placebo from randomization until cessation of study drug.

从随机分组开始，每日给予100毫克阿司匹林或安慰剂，直至研究药物停用。

main_outcomes_and_measures

Outcomes were physician-adjudicated incident cancer, type, stage at diagnosis, and cancer mortality.

结果包括医生判定的初次癌症发生、类型、诊断时的分期以及癌症死亡率。

Results

In 19 114 community-dwelling older adults (mean [SD] age, 75.1 [4.5] years; 56.4% female), a total of 3448 incident cancers and 1173 cancer-related deaths occurred over 10 years of follow-up (median, 8.6 [IQR, 7.4-10.0] years) during ASPREE and ASPREE-XT.

在19,114名社区居住的老年人（平均[标准差]年龄为75.1[4.5]岁；56.4%为女性）中，10年的随访期间（中位数为8.6年，四分位数间距为7.4-10.0年）共发生了3448例初次癌症和1173例与癌症相关的死亡，这些数据来自ASPREE和ASPREE-XT研究。

LDA was not associated with overall cancer incidenceover the long term (hazard ratio[HR] = 0.98; 95% CI, 0.92-1.05), by stage at diagnosis or cancer type, including colorectal cancer (HR = 1.01; 95% CI, 0.84-1.21).

长期来看，LDA与总体癌症发生率无关（风险比[HR] = 0.98; 95% 置信区间, 0.92-1.05），无论是按诊断时的癌症阶段还是癌症类型，包括结直肠癌（HR = 1.01; 95% 置信区间, 0.84-1.21）。

However, LDA was associated with increased cancer-related mortality (HR = 1.15; 95% CI, 1.03-1.29).

然而，LDA与癌症相关死亡率增加有关（HR = 1.15; 95% 置信区间, 1.03-1.29）。

Among 14 907 participants without cancer during the RCT and consented into ASPREE-XT (median age, 78.6 years [IQR, 76.2-82.1]; 57.5% female), 1451 incident cancers and 376 cancer deaths occurred in the post-RCT period, during which original aspirin assignment during the RCT was not associated with differences in cancer incidence(HR = 0.91; 95% CI, 0.82-1.01) or cancer-related mortality (HR = 1.02; 95% CI, 0.83-1.25) compared with original placebo assignment.

在14,907名在随机对照试验（RCT）期间无癌症且同意进入ASPREE-XT的参与者中（中位年龄78.6岁 [四分位数范围, 76.2-82.1]；女性占57.5%），在RCT后的随访期间共发生1451例新发癌症和376例癌症死亡。在此期间，与原始安慰剂分配相比，原始阿司匹林分配与癌症发生率（HR=0.91；95%置信区间，0.82-1.01）或与癌症相关的死亡率（HR=1.02；95%置信区间，0.83-1.25）无显著差异。

conclusions_and_relevance

In this study, over a median of 8.6 years, LDA was not associated with incident cancer among older adults, but cancer mortality risk was significantly elevated.

在这项研究中，经过中位8.6年的随访，低剂量阿司匹林（LDA）与老年人群中癌症发生无关联，但癌症死亡风险显著升高。

However, the elevated cancer mortality risk seen with aspirin for participants in the RCT period did not persist into the post-RCT observation period, suggesting no legacy effect.

然而，在随机对照试验（RCT）期间观察到的阿司匹林使用者癌症死亡风险增加并未持续到RCT后的观察期，这表明没有长期效应。