Examining the impact of regular aspirin use and PIK3CA mutations on survival in stage 2 colon cancer

Caitlin Murphy, Natalie Turner, Hui Li Wong, Mathu Sinnathamby, Jeanne Tie, Belinda Lee, Jayesh Desai, Iain Skinner, Michael Christie, Ryan Hutchinson, Sebastian Lunke, Paul Waring, Peter Gibbs, Ben Tran

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background/Aim: Data suggest aspirin improves survival in colorectal cancer (CRC) harbouring PIK3CA mutations. The impact of aspirin is thought predominantly to be through an anti-inflammatory effect. The aim of this study is to explore the effect of aspirin use on survival in a real-world cohort of stage 2 colon cancer (CC) patients. Methods: A prospective CRC database identified patients diagnosed with stage 2 CC between 2000 and 2011. PIK3CA mutation status was determined by next generation sequencing. Neutrophil-lymphocyte ratio greater than 5 at diagnosis represented systemic inflammation. Chart review was used to record regular aspirin use at diagnosis. Clinico-pathological features and survival data were available. Survival analyses used the Cox proportional hazards method. Results: Of 488 patients with stage 2 CC, 95 patients were aspirin users and 70 patients had PIK3CA mutations. Aspirin users were more likely to be older (median: 76.4 years vs 68.3 years, P < 0.001), to be less fit (American Society of Anaesthetists Score 3–4: 58% vs 31%, P < 0.001) and to have systemic inflammation (neutrophil-lymphocyte ratio > 5: 39% vs 27%, P = 0.027). Regular aspirin use did not significantly improve recurrence-free survival. In the PIK3CA mutated group, there was a trend towards improved recurrence-free survival (hazard ratio: 0.45, P = 0.42). Conclusions: Our study did not demonstrate a significant survival advantage from aspirin use in stage 2 PIK3CA mutated CC. The ‘real-world’ nature of our cohort and the subsequent uncontrolled differences in age and fitness in aspirin users are likely to have contributed to this result. Defining the true impact of aspirin in CRC requires prospective randomised clinical trials.

Original languageEnglish (US)
Pages (from-to)88-98
Number of pages11
JournalInternal Medicine Journal
Volume47
Issue number1
DOIs
StatePublished - Jan 1 2017

Fingerprint

Colonic Neoplasms
Aspirin
Mutation
Survival
Colorectal Neoplasms
Recurrence
Survival Analysis
Neutrophils
Anti-Inflammatory Agents
Randomized Controlled Trials
Databases
Lymphocytes
Inflammation

Keywords

  • aspirin
  • colon cancer
  • colorectal cancer
  • PIK3CA
  • real-world data

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Examining the impact of regular aspirin use and PIK3CA mutations on survival in stage 2 colon cancer. / Murphy, Caitlin; Turner, Natalie; Wong, Hui Li; Sinnathamby, Mathu; Tie, Jeanne; Lee, Belinda; Desai, Jayesh; Skinner, Iain; Christie, Michael; Hutchinson, Ryan; Lunke, Sebastian; Waring, Paul; Gibbs, Peter; Tran, Ben.

In: Internal Medicine Journal, Vol. 47, No. 1, 01.01.2017, p. 88-98.

Research output: Contribution to journalArticle

Murphy, C, Turner, N, Wong, HL, Sinnathamby, M, Tie, J, Lee, B, Desai, J, Skinner, I, Christie, M, Hutchinson, R, Lunke, S, Waring, P, Gibbs, P & Tran, B 2017, 'Examining the impact of regular aspirin use and PIK3CA mutations on survival in stage 2 colon cancer', Internal Medicine Journal, vol. 47, no. 1, pp. 88-98. https://doi.org/10.1111/imj.13312
Murphy, Caitlin ; Turner, Natalie ; Wong, Hui Li ; Sinnathamby, Mathu ; Tie, Jeanne ; Lee, Belinda ; Desai, Jayesh ; Skinner, Iain ; Christie, Michael ; Hutchinson, Ryan ; Lunke, Sebastian ; Waring, Paul ; Gibbs, Peter ; Tran, Ben. / Examining the impact of regular aspirin use and PIK3CA mutations on survival in stage 2 colon cancer. In: Internal Medicine Journal. 2017 ; Vol. 47, No. 1. pp. 88-98.
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abstract = "Background/Aim: Data suggest aspirin improves survival in colorectal cancer (CRC) harbouring PIK3CA mutations. The impact of aspirin is thought predominantly to be through an anti-inflammatory effect. The aim of this study is to explore the effect of aspirin use on survival in a real-world cohort of stage 2 colon cancer (CC) patients. Methods: A prospective CRC database identified patients diagnosed with stage 2 CC between 2000 and 2011. PIK3CA mutation status was determined by next generation sequencing. Neutrophil-lymphocyte ratio greater than 5 at diagnosis represented systemic inflammation. Chart review was used to record regular aspirin use at diagnosis. Clinico-pathological features and survival data were available. Survival analyses used the Cox proportional hazards method. Results: Of 488 patients with stage 2 CC, 95 patients were aspirin users and 70 patients had PIK3CA mutations. Aspirin users were more likely to be older (median: 76.4 years vs 68.3 years, P < 0.001), to be less fit (American Society of Anaesthetists Score 3–4: 58{\%} vs 31{\%}, P < 0.001) and to have systemic inflammation (neutrophil-lymphocyte ratio > 5: 39{\%} vs 27{\%}, P = 0.027). Regular aspirin use did not significantly improve recurrence-free survival. In the PIK3CA mutated group, there was a trend towards improved recurrence-free survival (hazard ratio: 0.45, P = 0.42). Conclusions: Our study did not demonstrate a significant survival advantage from aspirin use in stage 2 PIK3CA mutated CC. The ‘real-world’ nature of our cohort and the subsequent uncontrolled differences in age and fitness in aspirin users are likely to have contributed to this result. Defining the true impact of aspirin in CRC requires prospective randomised clinical trials.",
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AU - Tie, Jeanne

AU - Lee, Belinda

AU - Desai, Jayesh

AU - Skinner, Iain

AU - Christie, Michael

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