ASPO Abstracts
Nonsteroidal Anti-Inflammatory Drug (NSAID) Use, Obesity, and Survival from Colorectal Cancer
Category: Inflammation & Cancer, Survivorship & Health Outcomes/Comparative Effectiveness Research
Conference Year: 2018
Abstract Body:
Regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) has been associated with decreased risk of developing colorectal cancer (CRC), and emerging evidence suggests improved overall survival for subsets of patients who regularly use NSAIDs following diagnosis. Conversely, obesity is a known CRC risk factor, yet its impact on survival is unclear. The effect of regular NSAID use on CRC survival in the context of obesity largely unknown. The purpose of this study is to analyze the influence of prediagnostic obesity with and without postdiagnostic NSAID use on overall survival in CRC patients. Patients participating in the Assessment of Targeted Therapies Against Colorectal Cancer (ATTACC) protocol at MD Anderson were invited to complete an environmental survey that includes data on NSAID use and self- reported weight history. These data were combined with information from the medical record to describe recent and ongoing NSAID use. Patients were followed-up for disease and survival outcomes through contact with study personnel and periodic letters from the institution. Survival was compared by obese vs non-obese and NSAID users vs nonusers. Results were adjusting for or stratified by gender, race/ethnicity, and stage at diagnosis using Cox Proportional Hazards models and adjusted survival curves were generated using the ‘DIRECTADJ’ option. Obesity (BMI 30 kg/m2) was associated with worse overall survival than normal weight individuals, HR = 1.45 (95 % CI 1.10 — 1.90 P = 0.02). NSAID use was significantly linked to improved overall survival, HR = 0.81 (95 % CI 0.67 — 0.98; P = 0.03). However, when stratified by BMI, the protective effects of NSAIDs were only evident in the patients of BMI ‰¤ 25 kg/m2, HR = 0.75 (95 % CI 0.60 — 0.94; P = 0.04). Among colorectal cancer patients, obesity bodes a worse prognosis while NSAID use significantly improves overall survival, but only in patients of BMI ‰¤ 25 kg/m2. These results may help further understand how modifiable CRC risk factors could also impact survivorship. Furthermore, identifying subsets of patients most likely to benefit from postdiagnostic NSAID use is an important step toward minimizing toxicities through individualized recommendations, potentially improving treatment and survivorship of CRC overall.
Keywords: NSAIDs, aspirin, obesity, colorectal cancer, CRC