Aspirin use has been suggested to reduce cancer risk. However, previous studies showed inconsistent results as for the association between aspirin use and mortality in patients with hepatocellular carcinoma (HCC). The aim of the study was to evaluate the influence of aspirin use on clinical outcomes of patients with HCC in a meta-analysis.

Studies were obtained via systematic search of PubMed, Cochrane’s Library, and Embase databases. A random-effect model, which incorporated the potential heterogeneity, was used to pool the results.

Six retrospective cohort studies including 18,855 HCC patients that underwent liver resection or transarterial chemoembolization were included. Pooled results showed that compared to the non-users, aspirin users of HCC had significantly reduced risk of HCC recurrence (risk ratio [RR]: 0.74, 95% confidence interval [CI]: 0.59–0.93, p = 0.01; I² = 34%) and all-cause mortality (RR: 0.59, 95% CI: 0.47–0.73, p < 0.001; I² = 0%) after controlling of potential confounding factors. In addition, pooled results showed that aspirin use was not associated with a significantly increased risk of major bleeding events (RR: 1.42, 95% CI: 0.81–2.51, p = 0.22; I² = 29%) in patients with HCC.

Evidence from retrospective studies suggests that aspirin use is associated with reduced recurrence and all-cause mortality of HCC. These results should be validated in prospective cohort studies and randomized controlled trials.