Aspirin Decreases Hepatocellular Carcinoma Risk in Hepatitis C Virus Carriers: A Nationwide Cohort Study

Background Aspirin lowered some cancer occurrence rate, through the inhibition of the cyclooxygenase enzyme. The association of aspirin-use and hepatocellular carcinoma (HCC) occurrence rate in hepatitis B virus (HBV) carriers is well known. However, the association in hepatitis C virus (HCV) carriers is not known. Our purpose is comparing the HCC occurrence rate in HCV carriers with or without Aspirin treatment. Methods In this retrospective cohort study, the participants were ones newly-diagnosed with HCV from 2000 to 2012 in Taiwan. These HCV carriers with aspirin treatment were defined as the control group, whereas those without aspirin were defined as a compared cohort. We used a 1:1 propensity score matching by age, sex, comorbidities, drugs, diagnosis year and index year with covariate assessment. Results Our study sample consisted of 2980 aspirin-treated HCV carriers and 7771 non-aspirin-treated HCV carriers. After propensity score matching, each cohort consisted of 1911 HCV carriers. The adjusted hazard ratio (aHR) of HCC incidence in aspirin users (aHR=0.56, 95% CI=0.43-0.72, p < 0.001 ) was significantly lower than that in non-aspirin users. The Kaplan-Meier curves show that among the HCV carriers, aspirin users had a lower cumulative incidence rate of HCC in the first 10-year aspirin treatment course ( p < 0.0001 ). Conclusions The HCC incidence rate was lower in the aspirin users than non- aspirin users among HCV carriers, supporting the aspirin effect may be acting through inhibition of the cyclooxygenase enzyme pathway. Moreover, the patients got HCC protection by aspirin within 1-year treatment course and had best HCC prevention during 1- to 2-year aspirin treatment course. We encourage aspirin treatment to prevent HCC in HCV carriers.