University of Oulu

Holmberg, D., Kauppila, J.H., Mattsson, F. et al. Aspirin use in relation to long-term survival after gastrectomy for gastric adenocarcinoma. Gastric Cancer 25, 652–658 (2022).

Aspirin use in relation to long-term survival after gastrectomy for gastric adenocarcinoma

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Author: Holmberg, Dag1; Kauppila, Joonas H.1,2; Mattsson, Fredrik1;
Organizations: 1Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet and Karolinska University Hospital, Retzius Street 13A, 4thFloor, 171 77, Stockholm, Sweden
2Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland
3School of Cancer and Pharmacological Sciences, King’s College London, London, UK
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.4 MB)
Persistent link:
Language: English
Published: Springer Nature, 2022
Publish Date: 2022-09-15


Background: Low-dose aspirin use may reduce cancer incidence and mortality, but its influence on gastric adenocarcinoma survival is unclear. This study aimed to assess whether aspirin use improves long-term survival following gastrectomy for gastric adenocarcinoma.

Methods: This population-based cohort study included almost all patients who underwent gastrectomy for gastric adenocarcinoma in Sweden from 2006 to 2015, with follow-up throughout 2020. Preoperative exposure to a daily low-dose (75–160 mg) aspirin for 1 (main exposure), 2 and 3 years and for 1 year after gastrectomy was examined in relation to 5-year all-cause mortality (primary outcome) and disease-specific mortality. Multivariable Cox regression provided hazard ratios (HR) with 95% confidence intervals (CI), adjusted for age, sex, education, calendar year, comorbidity, statin use, tumour location, tumour stage, neoadjuvant chemotherapy, surgeon volume of gastrectomy and surgical radicality.

Results: Among 2025 patients, 545 (26.9%) used aspirin at the date of gastrectomy. Aspirin use within 1 year before surgery did not decrease the adjusted risk of 5-year all-cause mortality (HR = 0.98, 95% CI 0.85–1.13) or disease-specific mortality (HR = 1.00, 95% CI 0.86–1.17). Preoperative aspirin use for 2 years (HR = 0.98, 95% CI 0.84–1.15) or 3 years (HR = 0.94, 95% CI 0.79–1.12) did not decrease the risk of 5-year all-cause mortality. Patients remaining on aspirin during the first year after gastrectomy had a similar 5-year all-cause mortality as non-users of aspirin (HR = 1.01, 95% CI 0.82–1.25).

Conclusions: Low-dose aspirin use might not improve long-term survival after gastrectomy for gastric adenocarcinoma and may thus not be a target for adjuvant therapy in this group of patients.

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Series: Gastric cancer
ISSN: 1436-3291
ISSN-E: 1436-3305
ISSN-L: 1436-3291
Volume: 25
Issue: 3
Pages: 652 - 658
DOI: 10.1007/s10120-022-01282-0
Type of Publication: A1 Journal article – refereed
Field of Science: 3122 Cancers
Funding: Open access funding provided by Karolinska Institutet. The study was supported by the Swedish Research Council, Swedish Cancer Society, and Stockholm Cancer Society.
Dataset Reference: The data that support the findings of this study are available from The Swedish Board of Health and Welfare. Restrictions apply to the availability of these data, which were used under license for this study. The data are available from the authors with the permission of The Swedish Board of Health and Welfare.
Copyright information: © The Author(s) 2022. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit