Use of cyclooxygenase inhibitor and the risk of hepatocellular carcinoma in patients with chronic hepatitis B: A nested case‐control study using a nationwide population‐based data

摘要

Abstract The study aimed to investigate the relationship between the use of COX inhibitors and the risk of hepatocellular carcinoma (HCC) development in patients with chronic hepatitis B (CHB) using a nationwide population‐based data.?A nested case‐control study was conducted using the National Health Insurance Service–National Sample Cohort (NHIS‐NSC) from 2002 to 2013 in Korea. We compared the use of COX inhibitors between HCC cases and matched controls by categorizing 5 groups according to the cumulative defined daily dose (cDDD, 28, 28‐90, 91‐180, 181‐360, and 360) adjusting the use of antiviral agents. A total of 4980 patients with CHB were analysed as 996 HCC cases and 3984 matched controls. The number of COX inhibitor users (≥28?cDDD) was 358 patients (36%) and 1814 patients (45%) in the HCC group and control group, respectively. The use of COX inhibitors was significantly associated with a decreased risk of HCC development compared with nonusers (adjusted odds ratio [OR] 0.62, 95% confidence interval [CI] 0.52‐0.73, P ??.001). There was a dose‐dependent inverse relationship between the use of COX inhibitors and the risk of HCC. The adjusted ORs were 0.75 (95% CI: 0.63‐0.90), 0.41 (95% CI: 0.31‐0.56), 0.38 (95% CI: 0.25‐0.57) and 0.49 (95% CI: 0.31‐0.79) for the 28‐90, 91‐180, 181‐360 and 360 cDDDs, respectively ( P ??.01). In conclusion, the use of COX inhibitors was associated with a reduced risk of HCC in CHB. COX inhibitor may have a chemopreventive role in HCC development in patients with chronic liver disease.