Aspirin initiation and dose-dependent risk reduction of oral squamous cell carcinoma in areca nut chewers
Menée à l'aide de données 2008-2021 de l'Assurance maladie taïwanaise portant sur 50 606 consommateurs de noix d’arec, cette émulation d'essai cible évalue l'effet d'une utilisation d'aspirine sur le risque de carcinome épidermoïde de la cavité buccale, en fonction de la dose utilisée
Oral cavity squamous cell carcinoma (OCSCC) driven by areca nut consumption—a Group 1 carcinogen affecting 600 million people globally—represents a significant unmet need in precision prevention. Despite the known role of COX-2-mediated inflammation in this etiologic niche, pharmacological strategies remain under-evaluated.We emulated a target trial using a nationwide matched cohort of 50,606 areca nut chewers from the Taiwan National Health Insurance Research Database (2008 to 2021). To minimize selection and immortal time biases, we utilized time-dependent exposure modeling and Fine-Gray subdistribution hazard models to account for competing mortality.Aspirin initiation was associated with a significantly lower risk of incident OCSCC (adjusted sHR, 0.75; 95% CI, 0.65-0.87; P<.001). We identified a robust dose-response relationship, with a 43% risk reduction observed in the high-cumulative-exposure group (≥ median cDDD; sHR, 0.57; 95% CI, 0.47-0.69). The exploratory estimated 5-year number needed to treat (NNT) was 249 for the high-dose group. Sensitivity analyses, including E-value assessment (2.89) and landmark tracking, confirmed the stability of this association against unmeasured confounding and reverse causality.Our findings provide large-scale human evidence that sustained aspirin use significantly alters the trajectory of oral field cancerization in areca nut chewers. This study identifies aspirin as a high-priority candidate for risk-stratified chemoprevention in global populations with high areca nut exposure.
Journal of the National Cancer Institute , résumé, 2026