Yu Hui-Chuan, Luo Yan-Xin, Peng Hui, Wang Xiao-Lin, Yang Zi-Huan, Huang Mei-Jin, Kang Liang, Wang Lei, Wang Jian-Ping
Department of Colon and Rectum Surgery, The Sixth Affiliated Hospital (Guangdong Gastrointestinal and Anal Hospital), Sun Yat-sen University, Guangzhou, Guangdong, 510655, P. R. China.
Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital (Guangdong Gastrointestinal and Anal Hospital), Sun Yat-sen University, Guangzhou, Guangdong, 510655, P. R. China.
Chin J Cancer. 2016 Apr 11;35:38. doi: 10.1186/s40880-016-0100-8.
Several studies suggested that hypertension is positively related to cancer incidence and mortality. In this study, we investigated the association between perioperative blood pressure (BP) and long-term survival outcomes in patients with rectal cancer.
This study included a cohort of 358 patients with stages I-III rectal cancer who underwent a curative resection between June 2007 and June 2011. Both pre- and postoperative BPs were measured, by which patients were grouped (low BP: <120/80 mmHg; high BP: ≥120/80 mmHg). The survival outcomes were compared between these two groups. The primary endpoints were disease-free survival (DFS) and cancer-specific survival (CSS).
Univariate analysis showed that patients with high preoperative systolic BP had lower 3-year DFS (67.2% vs. 82.1%, P = 0.041) and CSS rates (81.9% vs. 94.8%, P = 0.003) than patients with low preoperative systolic BP, and the associations remained significant in the Cox multivariate analysis, with the adjusted hazard ratios equal to 1.97 [95% confidence interval (CI) = 1.08-3.60, P = 0.028] and 2.85 (95% CI = 1.00-8.25, P = 0.050), respectively. Similarly, in postoperative evaluation, patients with high systolic BP had significantly lower 3-year CSS rates than those with low systolic BP (78.3% vs. 88.9%, P = 0.032) in univariate analysis. Moreover, high pre- and/or postoperative systolic BP presented as risk factors for CSS in the subgroups of patients who did not have a history of hypertension, with and/or without perioperative administration of antihypertensive drugs.
High preoperative systolic BP was an independent risk factor for both CSS and DFS rates, and high postoperative systolic BP was significantly associated with a low CSS rate in rectal cancer patients. Additionally, our results suggest that rectal cancer patients may get survival benefit from BP control in perioperative care. However, further studies should be conducted to determine the association between BP and CSS and targets of BP control.
多项研究表明高血压与癌症发病率和死亡率呈正相关。在本研究中，我们调查了直肠癌患者围手术期血压（BP）与长期生存结局之间的关联。
本研究纳入了2007年6月至2011年6月期间接受根治性切除术的358例I - III期直肠癌患者队列。测量术前和术后血压，并据此将患者分组（低血压：<120/80 mmHg；高血压：≥120/80 mmHg）。比较两组的生存结局。主要终点为无病生存期（DFS）和癌症特异性生存期（CSS）。
单因素分析显示，术前收缩压高的患者3年DFS（67.2%对82.1%，P = 0.041）和CSS率（81.9%对94.8%，P = 0.003）低于术前收缩压低的患者，在Cox多因素分析中这些关联仍然显著，调整后的风险比分别为1.97 [95%置信区间（CI）= 1.08 - 3.60，P = 0.028]和2.85（95% CI = 1.00 - 8.25，P = 0.050）。同样，在术后评估中，单因素分析显示收缩压高的患者3年CSS率显著低于收缩压低的患者（78.3%对88.9%，P = 0.032）。此外，术前和/或术后收缩压高在无高血压病史、有和/或无围手术期使用降压药物的患者亚组中是CSS的危险因素。
术前收缩压高是CSS和DFS率的独立危险因素，术后收缩压高与直肠癌患者低CSS率显著相关。此外，我们的结果表明直肠癌患者在围手术期护理中进行血压控制可能获得生存益处。然而，应进行进一步研究以确定血压与CSS之间的关联以及血压控制目标。
