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Cancer Prevention Research
Cancer Prevention Research
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Research Article

Association of Aspirin, Metformin, and Statin Use with Gastric Cancer Incidence and Mortality: A Nationwide Cohort Study

Mi Hee Cho, Tae Gon Yoo, Su-Min Jeong and Dong Wook Shin
Mi Hee Cho
1Samsung C&T Medical Clinic, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Jongno-gu, Seoul, Republic of Korea (South).
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  • ORCID record for Mi Hee Cho
Tae Gon Yoo
2Department of Family Medicine, Hongseong Medical Center, Hongseong-gun, Chungcheongnam-do, Republic of Korea (South).
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Su-Min Jeong
3Department of Family Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Gwanak-gu, Seoul, Republic of Korea (South).
4Department of Family Medicine, Seoul National University Health Service Center, Gwanak-gu, Seoul, Republic of Korea (South).
5Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
6Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Jongno-gu, Seoul, Republic of Korea (South).
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Dong Wook Shin
6Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Jongno-gu, Seoul, Republic of Korea (South).
7Supportive Care Center, Samsung Comprehensive Cancer Center, Gangnam-gu, Seoul, Republic of Korea (South).
8Department of Digital Health, SAIHST, Sungkyunkwan University, Jongno-gu, Seoul, Republic of Korea (South).
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  • For correspondence: dwshin.md@gmail.com
DOI: 10.1158/1940-6207.CAPR-20-0123 Published January 2021
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Abstract

Anticancer effects of aspirin, metformin, and statins against gastric cancer, one of the most common cancers in the world, have been reported. This retrospective cohort study aimed to investigate independent associations of aspirin, metformin, and statin use with gastric cancer incidence and mortality after adjustment for concomitant use of other drugs, using pooled cohort data extracted from the Korean National Health Insurance claim database. Follow-up started on January 1, 2004 and ended at the date of gastric cancer diagnosis, death, or December 31, 2013. Exposures to drugs were defined as cumulative duration of use for aspirin and cumulative defined daily dose for metformin and statin, and were entered as time-dependent variables in Cox analysis models to avoid immortal time bias. Use of aspirin for longer than 182.5 and 547.5 days during 2-year interval was associated with reduced risks of gastric cancer incidence and mortality, respectively. Patients with diabetes were at higher risk of gastric cancer incidence and mortality than nondiabetic people, regardless of metformin treatment. However, metformin use among patients with diabetes was associated with a reduction in gastric cancer mortality in a dose-response manner. Statin use was also associated with a reduction of gastric cancer mortality in the general population, but not with gastric cancer incidence. In conclusion, long-term use of aspirin was independently associated with reduced incidence and mortality of gastric cancer in the general population, but metformin or statin use was only associated with a reduction of gastric cancer mortality in patients with diabetes and in the general population, respectively.

Prevention Relevance: Long-term use of aspirin was independently associated with reduced incidence and mortality of gastric cancer in the general population. Metformin or statin use, however, was only associated with a reduction of gastric cancer mortality in diabetic patients and in the general population in a dose-response manner, respectively.

Footnotes

  • Note: Supplementary data for this article are available at Cancer Prevention Research Online (http://cancerprevres.aacrjournals.org/).

  • Cancer Prev Res 2021;14:95–104

  • Received March 17, 2020.
  • Revision received July 6, 2020.
  • Accepted September 4, 2020.
  • Published first September 16, 2020.
  • ©2020 American Association for Cancer Research.
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Cancer Prevention Research: 14 (1)
January 2021
Volume 14, Issue 1
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Association of Aspirin, Metformin, and Statin Use with Gastric Cancer Incidence and Mortality: A Nationwide Cohort Study
Mi Hee Cho, Tae Gon Yoo, Su-Min Jeong and Dong Wook Shin
Cancer Prev Res January 1 2021 (14) (1) 95-104; DOI: 10.1158/1940-6207.CAPR-20-0123

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Association of Aspirin, Metformin, and Statin Use with Gastric Cancer Incidence and Mortality: A Nationwide Cohort Study
Mi Hee Cho, Tae Gon Yoo, Su-Min Jeong and Dong Wook Shin
Cancer Prev Res January 1 2021 (14) (1) 95-104; DOI: 10.1158/1940-6207.CAPR-20-0123
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