The Association of Aspirin Use with Survival Following Radical Cystectomy

Timothy D. Lyon, Igor Frank, Paras H. Shah, Robert Tarrell, John Cheville, Robert Jeffrey Karnes, R. Houston Thompson, Matthew K. Tollefson, Stephen A. Boorjian

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Purpose: Aspirin may have antineoplastic properties through the inhibition of inflammatory cytokines that regulate cell proliferation, angiogenesis and apoptosis. In patients with nonmuscle invasive bladder cancer aspirin use has been linked to a reduced risk of recurrence. We evaluated the association of aspirin with survival following radical cystectomy. Materials and Methods: A total of 1,061 patients underwent radical cystectomy at our institution between 2007 and 2016, of whom 461 (43%) were aspirin users at the time of surgery. Survival estimates were assessed by the Kaplan-Meier method. The Cox proportional hazards model was applied to evaluate associations between patient features and survival. Results: Median followup after radical cystectomy among survivors was 4.2 years (IQR 2–6.2). During this time 442 patients died, including 331 of bladder cancer. Aspirin users were significantly older, more likely to have a history of cardiovascular disease and diabetes, and more likely to use metformin or statin (each p <0.05). Nevertheless, we found that patients who ingested a daily aspirin had significantly higher 5-year cancer specific survival (68% vs 60%, p = 0.02) and overall survival (59% vs 52%, p = 0.03) compared to nonusers. Moreover, after multivariable adjustment aspirin use remained independently associated with lower cancer specific mortality (HR 0.64, 95% CI 0.45–0.89, p = 0.01) as well as all cause mortality (HR 0.70, 95% CI 0.53–0.93, p = 0.02) but not with distant metastasis (p >0.05). Conclusions: Daily aspirin use was associated with significantly improved survival outcomes following radical cystectomy. Further research is warranted to evaluate the potential underlying biological mechanisms and investigate causality.

Original languageEnglish (US)
Pages (from-to)1014-1021
Number of pages8
JournalJournal of Urology
Volume200
Issue number5
DOIs
StatePublished - Nov 1 2018

Fingerprint

Cystectomy
Aspirin
Survival
Urinary Bladder Neoplasms
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Metformin
Proportional Hazards Models
Causality
Antineoplastic Agents
Survivors
Cardiovascular Diseases
Cell Proliferation
Apoptosis
Cytokines
Recurrence
Research

Keywords

  • aspirin
  • bladder neoplasms
  • cystectomy
  • cytokines
  • mortality

ASJC Scopus subject areas

  • Urology

Cite this

Lyon, T. D., Frank, I., Shah, P. H., Tarrell, R., Cheville, J., Karnes, R. J., ... Boorjian, S. A. (2018). The Association of Aspirin Use with Survival Following Radical Cystectomy. Journal of Urology, 200(5), 1014-1021. https://doi.org/10.1016/j.juro.2018.05.119

The Association of Aspirin Use with Survival Following Radical Cystectomy. / Lyon, Timothy D.; Frank, Igor; Shah, Paras H.; Tarrell, Robert; Cheville, John; Karnes, Robert Jeffrey; Thompson, R. Houston; Tollefson, Matthew K.; Boorjian, Stephen A.

In: Journal of Urology, Vol. 200, No. 5, 01.11.2018, p. 1014-1021.

Research output: Contribution to journalArticle

Lyon, TD, Frank, I, Shah, PH, Tarrell, R, Cheville, J, Karnes, RJ, Thompson, RH, Tollefson, MK & Boorjian, SA 2018, 'The Association of Aspirin Use with Survival Following Radical Cystectomy', Journal of Urology, vol. 200, no. 5, pp. 1014-1021. https://doi.org/10.1016/j.juro.2018.05.119
Lyon, Timothy D. ; Frank, Igor ; Shah, Paras H. ; Tarrell, Robert ; Cheville, John ; Karnes, Robert Jeffrey ; Thompson, R. Houston ; Tollefson, Matthew K. ; Boorjian, Stephen A. / The Association of Aspirin Use with Survival Following Radical Cystectomy. In: Journal of Urology. 2018 ; Vol. 200, No. 5. pp. 1014-1021.
@article{2633568dba7543849691a51a72a91fe3,
title = "The Association of Aspirin Use with Survival Following Radical Cystectomy",
abstract = "Purpose: Aspirin may have antineoplastic properties through the inhibition of inflammatory cytokines that regulate cell proliferation, angiogenesis and apoptosis. In patients with nonmuscle invasive bladder cancer aspirin use has been linked to a reduced risk of recurrence. We evaluated the association of aspirin with survival following radical cystectomy. Materials and Methods: A total of 1,061 patients underwent radical cystectomy at our institution between 2007 and 2016, of whom 461 (43{\%}) were aspirin users at the time of surgery. Survival estimates were assessed by the Kaplan-Meier method. The Cox proportional hazards model was applied to evaluate associations between patient features and survival. Results: Median followup after radical cystectomy among survivors was 4.2 years (IQR 2–6.2). During this time 442 patients died, including 331 of bladder cancer. Aspirin users were significantly older, more likely to have a history of cardiovascular disease and diabetes, and more likely to use metformin or statin (each p <0.05). Nevertheless, we found that patients who ingested a daily aspirin had significantly higher 5-year cancer specific survival (68{\%} vs 60{\%}, p = 0.02) and overall survival (59{\%} vs 52{\%}, p = 0.03) compared to nonusers. Moreover, after multivariable adjustment aspirin use remained independently associated with lower cancer specific mortality (HR 0.64, 95{\%} CI 0.45–0.89, p = 0.01) as well as all cause mortality (HR 0.70, 95{\%} CI 0.53–0.93, p = 0.02) but not with distant metastasis (p >0.05). Conclusions: Daily aspirin use was associated with significantly improved survival outcomes following radical cystectomy. Further research is warranted to evaluate the potential underlying biological mechanisms and investigate causality.",
keywords = "aspirin, bladder neoplasms, cystectomy, cytokines, mortality",
author = "Lyon, {Timothy D.} and Igor Frank and Shah, {Paras H.} and Robert Tarrell and John Cheville and Karnes, {Robert Jeffrey} and Thompson, {R. Houston} and Tollefson, {Matthew K.} and Boorjian, {Stephen A.}",
year = "2018",
month = "11",
day = "1",
doi = "10.1016/j.juro.2018.05.119",
language = "English (US)",
volume = "200",
pages = "1014--1021",
journal = "Journal of Urology",
issn = "0022-5347",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - The Association of Aspirin Use with Survival Following Radical Cystectomy

AU - Lyon, Timothy D.

AU - Frank, Igor

AU - Shah, Paras H.

AU - Tarrell, Robert

AU - Cheville, John

AU - Karnes, Robert Jeffrey

AU - Thompson, R. Houston

AU - Tollefson, Matthew K.

AU - Boorjian, Stephen A.

PY - 2018/11/1

Y1 - 2018/11/1

N2 - Purpose: Aspirin may have antineoplastic properties through the inhibition of inflammatory cytokines that regulate cell proliferation, angiogenesis and apoptosis. In patients with nonmuscle invasive bladder cancer aspirin use has been linked to a reduced risk of recurrence. We evaluated the association of aspirin with survival following radical cystectomy. Materials and Methods: A total of 1,061 patients underwent radical cystectomy at our institution between 2007 and 2016, of whom 461 (43%) were aspirin users at the time of surgery. Survival estimates were assessed by the Kaplan-Meier method. The Cox proportional hazards model was applied to evaluate associations between patient features and survival. Results: Median followup after radical cystectomy among survivors was 4.2 years (IQR 2–6.2). During this time 442 patients died, including 331 of bladder cancer. Aspirin users were significantly older, more likely to have a history of cardiovascular disease and diabetes, and more likely to use metformin or statin (each p <0.05). Nevertheless, we found that patients who ingested a daily aspirin had significantly higher 5-year cancer specific survival (68% vs 60%, p = 0.02) and overall survival (59% vs 52%, p = 0.03) compared to nonusers. Moreover, after multivariable adjustment aspirin use remained independently associated with lower cancer specific mortality (HR 0.64, 95% CI 0.45–0.89, p = 0.01) as well as all cause mortality (HR 0.70, 95% CI 0.53–0.93, p = 0.02) but not with distant metastasis (p >0.05). Conclusions: Daily aspirin use was associated with significantly improved survival outcomes following radical cystectomy. Further research is warranted to evaluate the potential underlying biological mechanisms and investigate causality.

AB - Purpose: Aspirin may have antineoplastic properties through the inhibition of inflammatory cytokines that regulate cell proliferation, angiogenesis and apoptosis. In patients with nonmuscle invasive bladder cancer aspirin use has been linked to a reduced risk of recurrence. We evaluated the association of aspirin with survival following radical cystectomy. Materials and Methods: A total of 1,061 patients underwent radical cystectomy at our institution between 2007 and 2016, of whom 461 (43%) were aspirin users at the time of surgery. Survival estimates were assessed by the Kaplan-Meier method. The Cox proportional hazards model was applied to evaluate associations between patient features and survival. Results: Median followup after radical cystectomy among survivors was 4.2 years (IQR 2–6.2). During this time 442 patients died, including 331 of bladder cancer. Aspirin users were significantly older, more likely to have a history of cardiovascular disease and diabetes, and more likely to use metformin or statin (each p <0.05). Nevertheless, we found that patients who ingested a daily aspirin had significantly higher 5-year cancer specific survival (68% vs 60%, p = 0.02) and overall survival (59% vs 52%, p = 0.03) compared to nonusers. Moreover, after multivariable adjustment aspirin use remained independently associated with lower cancer specific mortality (HR 0.64, 95% CI 0.45–0.89, p = 0.01) as well as all cause mortality (HR 0.70, 95% CI 0.53–0.93, p = 0.02) but not with distant metastasis (p >0.05). Conclusions: Daily aspirin use was associated with significantly improved survival outcomes following radical cystectomy. Further research is warranted to evaluate the potential underlying biological mechanisms and investigate causality.

KW - aspirin

KW - bladder neoplasms

KW - cystectomy

KW - cytokines

KW - mortality

UR - http://www.scopus.com/inward/record.url?scp=85053702197&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85053702197&partnerID=8YFLogxK

U2 - 10.1016/j.juro.2018.05.119

DO - 10.1016/j.juro.2018.05.119

M3 - Article

C2 - 29857079

AN - SCOPUS:85053702197

VL - 200

SP - 1014

EP - 1021

JO - Journal of Urology

JF - Journal of Urology

SN - 0022-5347

IS - 5

ER -