Aspirin Use Prior to Radical Cystectomy Linked to Improved Survival

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Daily use of aspirin before radical cystectomy is associated with a significant 36% and 30% decreased risk of cancer-specific and all-cause mortality.
Daily use of aspirin before radical cystectomy is associated with a significant 36% and 30% decreased risk of cancer-specific and all-cause mortality.
The following article is part of conference coverage from the 2018 American Urological Association meeting in San Francisco. Renal and Urology News' staff will be reporting live on medical studies conducted by urologists and other specialists who are tops in their field in kidney stones, prostate cancer, kidney cancer, bladder cancer, enlarged prostate, and more. Check back for the latest news from AUA 2018. 

SAN FRANCISCO—Daily aspirin use prior to radical cystectomy (RC) for bladder cancer is associated with improved post-operative survival, investigators reported at the American Urological Association 2018 annual meeting.

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In a study of 1061 patients undergoing RC, including 461 (43%) who took daily aspirin preoperatively, Timothy D. Lyon, MD, and colleagues at Mayo Clinic in Rochester, Minnesota, found that after multivariable adjustment, daily aspirin use was independently associated with  significant 36% and 30% decreased risks of cancer-specific and all-cause mortality, respectively, compared with non-use of aspirin. Daily aspirin use was also associated with significantly greater 5-year cancer-specific survival (CSS, 68% vs 60%) and overall survival (59% vs 52%).

When the investigators categorized aspirin users according to low-dose (25, 81, or 162 mg) and high-dose (325 or 650 mg) use, they found that only low-dose aspirin was associated with improved CSS, a finding consistent with randomized trials involving patients with colorectal cancer. Daily users of low-dose aspirin had a significant 39% decreased risk of CSS compared with non-users.

The median follow-up after RC among patients who were alive at last follow-up was 4.2 years, during which442 patients died (331 from bladder cancer). Aspirin users were significantly older than non-users (median age 70 vs 66 years), and they were more likely to have a history of cardiovascular disease and diabetes.

Dr Lyon's team classified patients as aspirin users if aspirin was listed as a daily medication at a visit within 90 days of RC or on discharge paperwork after RC. Patients taking aspirin on an as-needed basis for pain were not classified as users, the authors noted.

In an interview with Renal & Urology News, Dr Lyon noted that the study findings notably are limited by missing information on duration of preoperative aspirin use and an inability to identify patients who began using daily aspirin following cystectomy, as this information is not captured in their registry.

“As such, prospective validation of these findings is required before aspirin can be confidently recommended for routine postoperative use,” Dr Lyon said. “However, we believe that our data provide a background and rationale for future investigations into the role of aspirin in post-cystectomy care. If these data can be prospectively confirmed, aspirin could potentially serve as a cheap and relatively nontoxic treatment adjunct for patients undergoing radical cystectomy.”

Dr Lyon explained that aspirin has long been recognized for its potential antineoplastic properties through its downregulation of inflammatory cytokines, most notably prostaglandin E2, thereby leading to decreases in cellular proliferation and angiogenesis. Daily aspirin use, he said, has been associated with reduced cancer-specific mortality in patients with colorectal, breast, and prostate cancers, as well as with reduced recurrence rates among patients with non-muscle invasive bladder cancer treated with bacillus Calmette-Guérin. A potential association between aspirin use and survival after RC has not been well characterized previously.

Visit Renal and Urology News' conference section for continuous coverage from AUA 2018.

Reference

Lyon TD, Frank I, Shah PH, et al. The association of aspirin use with survival following radical cystectomy. Data presented in poster format at the American Urological Association 2018 annual meeting, San Francisco, May 18–21. Abstract MP41-20.

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