This retrospective study used data from 343,966 newly diagnosed adult T2DM patients in Hong Kong between 2001 and 2015. Excluded were patients with prior PC, pancreatic cysts, IgG4 disease, or pancreatectomy, as well as those diagnosed with PC within one year of T2DM diagnosis to account for reverse causality. Aspirin use was treated as a time-varying variable to avoid immortal-time bias, defined as ≥180 days of use per year. The study used a multivariable Cox regression model and propensity-score matching to explore the effects of aspirin on risk of PC as well as PC-specific mortality.
Key findings
Pancreatic Cancer Incidence
• Of patients included in this cohort, 1,224 (0.36%) were diagnosed with PC during the follow-up period.
Risk of PC was significantly lower for aspirin use:
• Time-varying effect: aHR was 0.58 (95% CI 0.49 to 0.69).
• Propensity score matching analysis: aHR 0.61 (95% CI 0.48 to 0.77).
Dose-Response Relation
• A clear inverse relationship was noted, and higher doses and longer durations of aspirin use were associated with greater risk reduction (p<0.001).
PC-Related Mortality:
• PC-related deaths occurred in 787 (0.2%). Aspirin use significantly reduced PC-related mortality (aHR 0.43; 95% CI 0.34 to 0.53).
All-Cause Mortality:
• Among 51,151 deaths from any cause (14.9% of the cohort), aspirin use was associated with lower all-cause mortality (aHR 0.78; 95% CI 0.76 to 0.80).
The large-scale retrospective cohort study revealed significant associations of aspirin use with a reduction in PC risk, PC-related mortality, and all-cause mortality among patients with T2DM. Further prospective studies are necessary to validate the findings and provide evidence for benefits versus risks in routine clinical practice.
Reference:
Tan JT, Mao X, Cheng HM, Seto WK, Leung WK, Cheung KS. Aspirin is associated with lower risk of pancreatic cancer and cancer-related mortality in patients with diabetes mellitus. Gut. 2025 Jan 2:gutjnl-2024-333329. doi: 10.1136/gutjnl-2024-333329. Epub ahead of print. PMID: 39746785.
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