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ABSTRACT: We undertook a systematic review to synthesise the data on attitudes and behaviour towards the use of aspirin for cancer prevention, and healthcare providers' attitudes towards implementing aspirin in practice. Searches were carried out across 12 databases (e.g. MEDLINE, EMBASE). We used the Mixed Methods Appraisal Tool to evaluate study quality, and conducted a narrative synthesis of the data. The review was pre-registered (PROSPERO:CRD42018093453). Thirty-eight studies were identified. Uptake and adherence data were all from trials. Trials recruited healthy participants, those at higher risk of cancer, and those with cancer. Four studies reported moderate to high (40.9–77.7%) uptake to an aspirin trial among people who were eligible. Most trials (18/22) reported high day-to-day adherence (≥80%). Three trials observed no association between gender and adherence. One trial found no association between adherence and colorectal cancer risk. Three studies reported moderate to high (43.6–76.0%) hypothetical willingness to use aspirin. Two studies found that a high proportion of healthcare providers (72.0–76.0%) perceived aspirin to be a suitable cancer prevention option. No qualitative studies were identified. The likelihood that eligible users of aspirin would participate in a trial evaluating the use of aspirin for preventive therapy was moderate to high. Among participants in a trial, day-to-day adherence was high. Further research is needed to identify uptake and adherence rates in routine care, the factors affecting aspirin use, and the barriers to implementing aspirin into clinical care.

Systematic review

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期刊 medRxiv
Year 2022
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Colorectal adenomas have the potential of malignant transformation if left untreated. Multiple randomized controlled trials have been performed to evaluate the efficacy of aspirin in preventing colorectal adenoma recurrence in a population with a history of colorectal adenoma but not colorectal cancer, however, the relationship between aspirin dose and colorectal adenoma recurrence remains unclear. We conducted pairwise meta-analysis, meta-regression, trial sequential analysis, and network meta-analysis of all eligible studies. The ROB 2.0 tool was used to assess the risk of bias in the studies. The confidence in network meta-analysis (CINeMA) approach was used to evaluate the confidence of the network meta-analysis results. The network meta-analysis included eight RCTs (nine reports), comprising four on aspirin (low or high dose) alone and four on aspirin combined with another medication, all compared with placebo. In the network meta-analysis, low-dose aspirin (LDA <300 mg per day) was more effective than high-dose aspirin (HDA [&ge;]300 mg per day) and placebo, with risk ratios of 0.76 (95% CI: 0.58 to 0.99) and 0.7 (95% CI: 0.54 to 0.91), respectively. LDA was the optimal treatment relative to HDA and placebo (P-score = 0.99). In the trial sequential analysis, LDA was only more effective than placebo when the number of included participants exceeded the optimal information size; this was not the case for HDA. LDA has statistically significant efficacy for colorectal adenoma prevention, but compared with HDA, its efficacy remains uncertain. Further trials are therefore required.

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ABSTRACT: Colorectal cancer (CRC) is the fourth most common cancer and third leading cause of cancer-related death worldwide. Use of chemopreventive agents (CPAs) to reduce the incidence of precursor colorectal adenomas could lower the future burden of CRC. Many classes of potential CPAs have been investigated. To identify the most effective CPAs, we conducted a systematic review and a network meta-analysis (NMA). An electronic search was performed through August 2020 to identify all randomized controlled trials (RCTs) assessing the efficacy of CPAs in reducing the incidence of colorectal adenomas at the time of surveillance colonoscopy among patients who had previously undergone polypectomy during an index colonoscopy. In total, 33 RCTs were included in the NMA, which was conducted under a Bayesian inference framework. Random effects models were used with adjustment for follow-up length and control group event rates to yield relative risks (RRs) and 95% credible intervals (CrIs). Our full network consisted of 13 interventions in addition to a placebo arm. Of 20,925 included patients, 7766 had an adenoma. Compared to placebo, the combination of difluoromethylornithine (DFMO) + Sulindac (RR 0.24, CrI 0.10-0.55) demonstrated a protective effect, while aspirin had a RR of 0.77 (CrI 0.60-1.00), celecoxib 800 mg had a RR of 0.56 (CrI 0.31-1.01) and metformin had a RR of 0.56 (CrI 0.22-1.39). Our results suggest that select CPAs may be efficacious in preventing the development of adenomas. Further studies are needed to identify those patients most likely to benefit and the minimum effective dosages of CPAs.

Systematic review

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期刊 International journal of colorectal disease
Year 2021
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PURPOSE: Colorectal cancer is the second most common cause of cancer death worldwide. Aspirin, due to its antineoplastic effects, has been suggested to have chemopreventive effects on colorectal cancer based on recent trials. We conducted this systematic review and meta-analysis to provide an updated evidence about the long-term efficacy of daily aspirin use in the prevention of colorectal cancer. METHODS: We searched Medline/PubMed, Ovid, Web of Science, and Cochrane Library. We included randomized controlled trials (RCTs) that compared the efficacy of daily aspirin use to placebo in healthy individuals at the time of study entry. The desired outcomes of this review were the incidence of advanced lesions (i.e., adenomas with villous component, adenomas ≥1 cm in diameter, adenomas with high-grade dysplasia, and/or invasive cancer) and colorectal adenomas. RESULTS: A total of 15 articles representing 11 RCTs were included. Overall, the results indicated that aspirin significantly reduced the risk of developing colorectal adenomas but not advanced lesions at 3 years (risk ratio (RR) = 0.84, P < 0.05 and risk ratio = 0.82, P = 0.10, respectively). At 5 years, the risk of advanced lesions but not adenomas was reduced by aspirin (RR = 0.68, P < 0.05 and RR = 0.87, P = 0.22, respectively). Aspirin was not found to have an effect on the risk of advanced lesions or adenomas beyond 5 years (hazard ratio (HR) = 0.82, P = 0.07 and HR = 0.99, P = 0.82, respectively). CONCLUSION: Overall, aspirin (particularly high dose) only reduced the risk of advanced lesions up to 5 years.

Systematic review

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作者 Ma S , Han T , Sun C , Cheng C , Zhang H , Qu G , Bhan C , Yang H , Guo Z , Yan Y , Cao C , Ji Z , Zhou Q
期刊 International journal of colorectal disease
Year 2021
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BACKGROUND: Colorectal cancer (CRC) is the third most common diagnosed cancer and the third leading cause of all cancer deaths in the USA. Some evidences are shown that aspirin can reduce the morbidity and mortality of different cancers, including CRC. Aspirin has become a new focus of cancer prevention and treatment research so far; clinical studies, however, found conflicting conclusions of its anti-cancer characteristics. This study is to summarize the latest evidence of correlation between aspirin use and CRC and/or colorectal adenomas. METHODS: Databases were searched to identify randomized controlled trials (RCTs) in the salvage setting. The pooled relative risk (RR) with 95% confidence interval (CI) was used to estimate the effect of aspirin on colorectal cancer and/or colorectal adenomas. Subgroup analysis and sensitivity analysis were also conducted. RESULTS: The result showed that aspirin use was not associated with incidence of CRC (RR 0.97; 95% CI 0.84-1.12; P = 0.66; I2 = 34%), aspirin use was found to be associated with reduced recurrence of colorectal adenomas (RR 0.83; 95% CI 0.72-0.95; P = 0.006; I2 = 63%) and reduced mortality of CRC (RR 0.79; 95% CI 0.64-0.97; P = 0.02; I2 = 14%). Subgroup analysis found a statistically significant association in low dose with a pooled RR of 0.85 (95% CI 0.74-0.99; P = 0.03; I2 = 31%). CONCLUSIONS: This meta-analysis of randomized controlled trial data indicates that aspirin reduces the overall risk of recurrence and mortality of CRC and/or colorectal adenomas. Incidence of CRC was also reduced with low-dose aspirin. The emerging evidence on aspirin's cancer protection role highlights an exciting time for cancer prevention through low-cost interventions. TRIAL REGISTRATION: Clinicaltrials.gov no: CRD42020208852; August 18, 2020; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020208852 ).

Systematic review

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期刊 Clinical nutrition (Edinburgh, Scotland)
Year 2018
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Background & aims: To evaluate the controversies among the studies assessing the association between folic acid intake or folate status and colorectal cancer risk. Methods: PubMed, Cochrane library and references of related articles were searched from January 2000 to September 2016. Studies on folic acid intake or folate status and colorectal cancer or adenoma risk were included. Full text review was conducted for potentially eligible studies. Quality assessment was performed. Random-effects meta-analysis was used to estimate risk ratio and 95% Confidence Intervals. Analysis was conducted by Comprehensive Meta-Analysis software. Results: Folic acid supplement intake showed no significant effect on colorectal cancer risk in meta-analysis of randomized controlled trials, RR: 1.07 (95% CI: 0.86–1.43). The effect on risk was not significant in cohort studies either; RR = 0.96 (95% CI: 0.76–1.21). However, there was significant reduced colorectal cancer risk in total folate intake in cohort studies; 0.71 (95% CI: 0.59–0.86). Odds Ratio was also significantly reduced in case control studies; 0.77 (95% CI: 0.62–0.95). Nevertheless once folate status was measured as Red Blood Cell folate content, no significant effect on colorectal cancer risk was observed; 1.05 (95% CI: 0.85–1.30). Conclusion: The differences in bioavailability and metabolism of synthetic folic acid and natural dietary folate as well as variation in the baseline characteristics of subjects and various methods of folate status assessment might be the main reasons for these controversies. Findings of present study highlight the importance of individualized folic acid supplement intake given the fact that the beneficiary effects of long term folic acid supplementation is not confirmed. © 2017 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism

Systematic review

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期刊 BMJ (Clinical research ed.)
Year 2016
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背景:本文综合了痛经的综合概况,并对使用非甾体抗炎药(NSAIDs)和激素避孕药物治疗和治疗痛经的现有文献进行了系统综述。研究设计:从2004年起,综合搜索PubMed数据库进行临床试验和痛经治疗的观察性研究。结果:确定了十八种出版物。评估用于治疗原发性痛经的NSAIDs的10项随机对照试验(RCT)与安慰剂相比表现出优异的疼痛缓解,但在不同的NSAIDS之间没有建立优势。两项RCTs和六项非随机观察或前瞻性研究评估荷尔蒙避孕药对痛经的影响,强烈表明对痛经痛痛缓解有益,主要在NSAID试验(N = 10〜 -337)。与平行的替代或以前使用的激素避孕药相比,乙炔雌二醇/醋酸氯地孕酮是唯一提供痛觉痛的更明显缓解的制剂。激素避孕研究之间的方法学不一致。结论:本次审查的结果支持使用NSAIDs作为一线治疗疼痛缓解痛经的女性,而不希望避孕。对于希望避孕的女性,联合口服避孕药(COC)是痛经缓解疼痛的优惠疗法,因为痛经缓解的额外非避孕益处与额外的风险无关,消除了与服用NSAID相关的风险,更适合长期选择。建议通过改进方法来加强未来试验的影响。

Systematic review

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作者 van Dijk M , Pot GK
期刊 European journal of clinical nutrition
Year 2016
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背景:许多研究证明,碘化钠对映体(NIS)在放射性碘(RAI)治疗甲状腺癌中起着关键作用,但越来越多的研究表明部分NIS过度表达的分化型甲状腺癌(DTC)对RAI不敏感。目的:荟萃分析的目的是评估NIS在分化型甲状腺癌中的表达,与正常甲状腺组织相比。目前,数据来源:PUBMED,Sinomed,CNKI,Wanfang和VIP被搜查相关病例对照研究。研究选择:包括DTC中定性表达NIS的研究。数据提取:独立工作,作者使用标准表单提取数据。对于质量评估,应用了新堡渥太华量表(NOS)。资料合成:共有9项合格研究,涉及765例,473例。结果显示,与对照组相比,NIS的表达差异有统计学意义(OddsRadio OR:1.47,95%CI:1.12〜1.94,Z = 2.78,P = 0.005)。由于存在显着的异质性,进行亚组分析和敏感性分析,发现异质性来自评估阳性NIS表达的不同标准(Liu 2008,Mu 2010)和对照组的小简单(Lin.J D2001 )。去除这些研究后,异质性消失或降至50%以下。结论:我们的研究表明,NTC的表达在DTC中显着增加,这有助于解释RAI治疗反应差的个体的原因。换句话说,甲状腺癌中减少的碘摄取可能不是由NIS的表达降低引起的,NIS蛋白的功能或其转录后易位可能是重点。

Systematic review

Unclassified

期刊 Asian Pacific journal of cancer prevention : APJCP
Year 2016
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BACKGROUND: Through search the possible randomized control trials, we make a renewed meta-analysis in order to assess the impact of aspirin in preventing the recurrence of colorectal adenoma. MATERIALS AND METHODS: The Medicine/PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Chinese biomedical literature service system (SinoMed) databases were searched for the related randomized controlled trials until to the April 2016. Three different authors respectively evaluated the quality of studies and extracted data, and we used the STATA software to analyze, investigate heterogeneity between the data, using the fixed-effects model to calculate and merge data. RESULTS: 7 papers were included the renewed meta- analysis, among these studies, two pairs were identified as representing the same study population, with the only difference being the duration of follow-up. Thus there were only five papers included our meta-analysis, and one Chinese paper were also included the work. Results were categorized by the length of follow-up, different kinds of people, varied dose of oral aspirin. The relative of adenoma in patients taking aspirin vs placebo were 0.73 (95% CI 0.55-0.98, P=0.039) with 1 year follow up; 0.84 (95% CI 0.72-0.98, P=0.484) with greater than 1 year follow up; for the advanced adenoma, the RR 0.68 (95% CI 0.49-0.94, P=0.582),for one year; RR=0.75 (95% CI 0.52-1.07, P=0.552) for greater one year. Furthermore the white population could divided into two subgroups according to the different length of follow-up time. When the length of follow-up time less than 3-year, The RR of two subgroups respective were RR=0.86 (95% CI 0.76-0.98, P=0.332), I2=0%, RR=0.68 (95% CI 0.47-0.98, P=0.552), I2=64.6%, But with the extension of follow-up time greater than 2-year, with the white, oral aspirin without considering dose had no efficacy on preventing the recurrence of any adenoma, the RR was 0.86 (95% CI 0.71-1.05, P=0.302), I2=16.4%. CONCLUSIONS: This meta-analysis indicated that oral aspirin is associated with a remarkable decrease in the recurrence of any adenoma and advanced adenomas in patients follow-up for 1 year without concerning the dose of aspirin, but with the extension of follow-up time for greater than 1 year, oral aspirin can be effective on preventing the recurrence of any adenoma, but for the advanced adenoma, the result indicated that oral aspirin had no efficacy, According to the inclusion of ethnic groups, we also divided relevant papers into two subgroups as the yellow and white group. Then the follow-up time was less than 3 years, oral aspirin without considering the dose, had an significant efficacy on preventing the recurrence of any adenoma. But with the follow-up greater than 2 years, oral aspirin had no effect in the white.

Systematic review

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U.S. Preventive Services Task Force Evidence Syntheses, formerly Systematic Evidence Reviews
Year 2015
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目的:评估印度乙型肝炎患病率。设计:对国家不同地区的流行率数据进行元分析。数据来源:Medline,Cochrane图书馆和最佳下注以及之前的评论进行了搜索。交叉引用的手搜搜索也是有限的。最后与专家磋商,扩大参考基准。回顾方法:选择报告HBsAg患病率的研究。排除高风险群体的数据。主要结果:54篇论文报告了61个人群的数据。使用所采用的检测的特异性和灵敏度,从报告的流行率计算每项研究的真实流行率。非部族人群的真正流行率为2.4%(95%CI:2.2%-2.7%)。部族人群中真正的流行率为15.9%(CI:11.4%-20.4%)。结论:这些数字可能有助于估计该国疾病的负担,并预测免疫的成本效益。