Wang Xuanji, Sweigert Patrick, Eguia Emanuel, Varsnik M Alyssa, Renz Christen R, Terrasse Weston A, Gauthier Madeline, Aranha Gerard, Knab Lawrence M, Abood Gerard
Department of Surgery, Loyola University Medical Center, Maywood, IL.
Surg Open Sci. 2020 Sep 16;3:34-38. doi: 10.1016/j.sopen.2020.08.001. eCollection 2021 Jan.
Angiotensin system inhibitors are associated with improved prognosis in patients with gastrointestinal and hepatobiliary cancers. Data suggest that renin-angiotensin system signaling stimulates the tumor's immune microenvironment to impact overall survival. The goal of this study is to investigate the role of angiotensin system inhibitor use on the overall survival and disease-free survival of esophageal cancer patients.
Retrospective review of esophagectomy patients with esophageal adenocarcinoma and squamous cell cancer at a single institution tertiary care center from 2007 to 2018 was performed. Outcomes include overall survival and disease-free survival. Patient characteristics were compared with test and test. Survival was analyzed with Kaplan-Meier and Cox proportional-hazards regression.
One hundred seventy-one patients were identified and 123 underwent esophagectomy for cancer. No significant differences in patient demographics were found between angiotensin system inhibitor users and non-angiotensin system inhibitor users except for the rates of hypertension (40% vs 94%, < .01) and diabetes (16% vs 47%, < .01). Distributions of tumor neoadjuvant therapy, adjuvant therapy, pathology, staging, margins, and surgical approach were similar. Postoperatively, there was no difference in major adverse cardiovascular events or infection rates. This study did not find any differences in overall survival and disease-free survival between angiotensin system inhibitor users and non-angiotensin system inhibitor users.
Angiotensin system inhibitors have been shown to improve survival and decrease relative risk for several types of cancers; however, our data do not support the same effect on esophageal cancer patients undergoing curative intent surgery. Further research is needed to investigate potential nuances in angiotensin system inhibitor dose, chronicity of use, esophageal pathology, and applicability to nonsurgical candidates.
血管紧张素系统抑制剂与胃肠道和肝胆系统癌症患者预后改善相关。数据表明，肾素 - 血管紧张素系统信号传导刺激肿瘤的免疫微环境，从而影响总生存期。本研究的目的是调查血管紧张素系统抑制剂的使用对食管癌患者总生存期和无病生存期的作用。
对2007年至2018年在一家单一机构三级医疗中心接受食管腺癌和鳞状细胞癌食管切除术的患者进行回顾性研究。结局指标包括总生存期和无病生存期。患者特征采用卡方检验和t检验进行比较。采用Kaplan-Meier法和Cox比例风险回归分析生存期。
共识别出171例患者，其中123例接受了癌症食管切除术。血管紧张素系统抑制剂使用者和非使用者之间，除高血压发生率（40% 对94%，P <.01）和糖尿病发生率（16% 对47%，P <.01）外，患者人口统计学特征无显著差异。肿瘤新辅助治疗、辅助治疗、病理、分期、切缘和手术方式的分布相似。术后主要不良心血管事件或感染率无差异。本研究未发现血管紧张素系统抑制剂使用者和非使用者在总生存期和无病生存期方面存在任何差异。
血管紧张素系统抑制剂已被证明可改善多种癌症类型的生存期并降低相对风险；然而，我们的数据不支持其对接受根治性手术的食管癌患者有同样的效果。需要进一步研究以调查血管紧张素系统抑制剂剂量、使用时长、食管病理以及对非手术候选者的适用性等潜在细微差别。
