Non-steroidal anti-inflammatory drug use and the risk of gastric cancer: a systematic review and meta-analysis

J Natl Cancer Inst. 2003 Dec 3;95(23):1784-91. doi: 10.1093/jnci/djg106.


Background: The relationship between the use of non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin, and the risk of gastric cancer has not been well studied. We performed a systematic review and meta-analysis of published studies to evaluate the association between use of this class of drugs and the risk of gastric cancer.

Methods: A fully recursive literature search to January 2003 was conducted in MEDLINE, PubMed, and CANCERLIT to identify potentially relevant case-control or cohort studies. Summary odds ratios (ORs) and 95% confidence intervals (CIs) were calculated under a random-effects model.

Results: Nine studies (eight case-control and one cohort) with a total of 2831 gastric cancer case patients were identified. NSAID use was associated with a reduced risk of gastric cancer, with a summary odds ratio of 0.78 (95% CI = 0.69 to 0.87). Users of aspirin (OR = 0.73, 95% CI = 0.63 to 0.86) and non-aspirin NSAIDs (OR = 0.74, 95% CI = 0.55 to 1.00) experienced similar magnitudes of risk reduction. Regular users of NSAIDs (OR = 0.57, 95% CI = 0.44 to 0.74) experienced a lower risk of gastric cancer relative to nonusers than did irregular users (OR = 0.76, 95% CI = 0.62 to 0.94; P =.09 versus regular users). A stratified analysis showed that NSAID use was associated with a statistically significant reduction in risk of noncardia gastric cancer (OR = 0.72, 95% CI = 0.58 to 0.89), but not of gastric cancer at the cardia (OR = 0.80, 95% CI = 0.53 to 1.20). There was no evidence that study design or type of control subject substantially influenced the estimate of effects.

Conclusion: NSAID use was associated with a decreased risk of gastric cancer in a dose-dependent manner. This finding warrants proper clinical trials in populations with high risk of gastric cancer.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Anti-Inflammatory Agents, Non-Steroidal / administration & dosage*
  • Anti-Inflammatory Agents, Non-Steroidal / pharmacology*
  • Anticarcinogenic Agents / administration & dosage*
  • Anticarcinogenic Agents / pharmacology*
  • Cardia
  • Case-Control Studies
  • Cohort Studies
  • Dose-Response Relationship, Drug
  • Helicobacter Infections / complications
  • Helicobacter pylori
  • Humans
  • Incidence
  • Odds Ratio
  • Research Design
  • Risk Assessment
  • Stomach Neoplasms / epidemiology
  • Stomach Neoplasms / microbiology
  • Stomach Neoplasms / prevention & control*


  • Anti-Inflammatory Agents, Non-Steroidal
  • Anticarcinogenic Agents